Treatment of insomnia, restless legs, cramps, and pain associated with chronic kidney disease: results from a multinational survey of kidney supportive care practice

Abstract

Background: Kidney failure is associated with a high symptom burden, yet few studies describe real-world management approaches. Methods: Kidney care units in Australia, New Zealand (NZ) and the United Kingdom (UK) were surveyed regarding their pharmacological treatment of a range of common symptoms affecting those with kidney failure. The present report describes the results for insomnia, restless legs syndrome (RLS), cramps, and pain. Variation in responses was described using normalised generalised variance (NGV), resulting in a score from 1 (most diverse) to 0 (least diverse). Results: One hundred and twelve (of 171 contacted) kidney units responded, including 56 units in Australia (50%), 7 in NZ (6%), and 49 in the UK (44%). Diversity of practice was highest for insomnia (mean NGV 0.95, range 0.93–0.98), where melatonin was the leading first-line agent (38%), followed by zolpidem and zopiclone (29%). Diversity of practice was lowest for RLS (mean NGV 0.66, range 0.30–0.99), owing to widespread use of iron replacement as first line (69%), gabapentinoids (45%), and dopamine agonists (37%). Diversity of practice was moderate for neuropathic pain (mean NGV 0.71, range 0.44–0.93), cramps (mean NGV 0.72, range 0.48–0.97), and opioids (mean NGV 0.88, range 0.75–0.97). Numerous significant between-country differences in treatment preferences were noted. Conclusions: There is wide variation in treatment approaches to common symptoms affecting people living with advanced CKD or kidney failure, both within and between countries, indicating a need for evidence-based guidelines and further randomised studies to inform practice. Clinical trial number: Not applicable.