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2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Publication:
Hemodialysis.com Author Interview: Miklos Zsolt Molnar, MD, PhD

Periodic limb movements in sleep are associated with stroke and cardiovascular risk factors in patients with renal failure.
Lindner A, Fornadi K, Lazar AS, Czira ME, Dunai A, Zoller R, Veber O, Szentkiralyi A, Kiss Z, Toronyi E, Mucsi I, Novak M, Molnar MZ.

Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary Department of Neurology, Semmelweis University, Budapest, Hungary Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany Amgen Hungary Limited, Budapest, Hungary Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary Department of Medicine, Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada Institute of Pathophysiology, Semmelweis University, Budapest, Hungary Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
J Sleep Res. 2011 Sep 14. doi: 10.1111/j.1365-2869.2011.00956.x.

What are the main findings of the study?

Higher Periodic Limb Movements in Sleep (PLMS) index, which is defined as the average of number of periodic limb movements/hour during sleep, is an independent predictor of higher cardiovascular and cerebrovascular risk score in patients with chronic kidney disease. Very similar result was recently published in elderly men in Circulation.

Were any of the findings unexpected?

After adjusment for several important co-variables, we found linearly-increasing, dose-response relationship between PLMI and cardio-cerebro-vascular risk in both waitlisted dialyzed and kidney transplant recipients.

What should clinicians and patients take away from this study?

PLMS is an independent predictor of cardiovascular risk in ESRD patients. Although we clearly cannot claim causality between PLMS and cardiovascular risk, together with the published evidence our results contribute to the question of whether treating PLMS successfully would reduce cardiovascular risk.

What recommendations do you have for nephrology health care providers as a result of your study?

Regular assessment of sleep disorders is needed in both dialyzed and kidney transplant patients.

Periodic limb movements in sleep (PLMS) is prevalent among dialysed patients and is associated with increased risk of mortality. Our study aimed to determine the prevalence of this disease in a sample of transplanted and waiting-list haemodialysed patients.

One hundred transplanted and 50 waiting-list patients underwent polysomnography. Moderate and severe diseases were defined as periodic limb movements in sleep index (PLMSI) higher than 15 and 25 events h(-1) , respectively. The 10-year coronary heart disease risk was estimated for all patients using the Framingham Score. Moreover, the 10-year estimated risk of stroke was calculated according to the modified version of the Framingham Stroke Risk Profile. PLMS was present in 27% of the transplanted and 42% of the waiting-list 0.094); the proportion of severe disease was twice as high = group (P 0.024). = in waiting-list versus transplanted patients (32 versus 16%, P Patients with severe disease had a higher 10-year estimated risk of 0.002] = stroke in the transplanted group [10 (7-17) versus 5 (4-10); P and a higher 10-year coronary heart disease risk in both the 0.002], and the = transplanted [18 (8-22) versus 7 (4-14); P 0.032]. In = waiting-list groups [11 (5-18) versus 4 (1-9); P multivariable linear regression models the PLMSI was associated independently with the Framingham cardiovascular and cerebrovascular scores after adjusting for important covariables.

Higher PLMSI is an independent predictor of higher cardiovascular and cerebrovascular risk score in patients with chronic kidney disease.

Severe PLMS is less frequent in kidney transplant recipients compared to waiting-list dialysis patients.