Table 2.

Pharmacological Treatment of CKD-A-RLS.

NAME OF THE DRUG (S)	DESIGN OF STUDY	NUMBER OF PATIENTS, DOSE	RESULTS	SIDE EFFECTS
Levodopa [45]	Double blind, cross over for 4 weeks	15, 100 & 200 mg	Improved leg movements, PLM index, sleep quality and QoL (Ps < 0.03)	Dry mouth and headaches
Gabapentin [46]	Double blind, crossover for 4 weeks (1 week wash out)	15, 200 & 300 mg	11 patients responded to gabapentin,1 to both placebo and gabapentin	Two drop-outs, one due to lethargy, one due to MI (unrelated to drug)
Rotigotine patch, Stage 2 CKD [47]	Single center Prospective, open label	14, 1 mg, 2 mg	Improved: severity of Symptoms (p < 0.003), QoL (P < 0.001, sleep (P < 0.001).	One patient:GI upset, no augmentation
Gabapentin [48]	Single center, Retrospective	59: GP 50 and 100 mg 125: controls	No effect	In gabapentin group, 17% discontinued treatment
Rotigotine patch [49] CKD/HD	Double blind, placebo controlled	15 Rotigotine 1 to 3 mg, 3 times daily for 3 weeks 10 Placebo	At the end of study: 10 of 15 and 2 of 10 showed significant improvement of RLS score in Rotigotine and placebo groups, respectively.	Nausea 20% Vomiting 15%
Low dose ropinirole vs aerobic exercise vs placebo 4 hours HD, 3 sessions/week [50]	Partially, double blind/placebo controlled	0.25 mg ropinirole, 2 h before sleep, 45 minutes cycling during each HD session Ropinirole 7 Exercise 15 Placebo 7	Ropinirole and aerobic exercise equally improved IRLS scores, QoL and depression. Ropinirole improved sleep quality	No side effects
Gabapentin (GP) versus Levodopa (LD) [51]	Double blind	GP: 42 LD: 40 GP: 200 mg/d LD: 110 mg/d Over 4 weeks	Both reduced IRLS scores but GP was more effective (P < 0.016). Both improved quality of sleep	Transient hypotension in two patients who took Levodopa. Increased day time sleepiness GP > LD
Gabapentin (GP) versus Levodopa (LD) [52] Hemodialysis: 3 times/week	Observational Cross sectional	GP: 14 LD: 12 GP: 200 mg/after each dialysis session LD: 110 mg/day 4 weeks treatment duration	IRLSS score was significantly improved after both Gabapentin and Levodopa treatment (P = 0.0001). Gabapentin was superior to L-Dopa in improving quality of sleep and QoL	Not mentioned
Gabapentin versus levodopa [53] Hemodialysis 3 times/week	Open label Prospective	GP# 15 LD#15 Gabapentin: 200 mg after each dialysis session LD: 125 mg, 2 hours before sleep	Both improved IRLSS scores. Gabapentin was superior to levodopa in improving sleep quality and latency, QoL (measured by SF36), general health and body pain	One patient dropped from the study due to gabapentin side effect (type not mentioned).
Ropinirole versus levodopa-SR [54] Chronic hemodialysis patients	Randomized, cross-over	10 Levodopa 190 mg/day Ropinirole 1.45 mg/day Duration 14 weeks (4 weeks each trial with 6 weeks washout)	At the end of study, ropinirole was superior to levodopa regarding improving scores of six item IRLS and increasing sleep time (P < 0.001) as well as improvement of clinical impression scorea (P < 0.01)	One patient taking levodopa withdrew from the study due to vomiting

GP: gabapentin; LD: levodopa; QOL-quality of life; HD: hemodialysis.