Mrs Natividad Miles1
1Sydney Local Health District, Camperdown, Australia
Biography:
Natty Miles is a highly experienced renal and palliative care nurse. With a strong background in managing chronic kidney disease (CKD), with expertise in person-centred care, shared decision making and palliative care principles. Currently based at Royal Prince Alfred Hospital, in which she holds the position of Kidney Supportive Care Clinical Nurse Consultant.
Abstract:
Background:
Restless Legs Syndrome (RLS) is a sensorimotor disorder characterised by an irresistible urge to move the limbs, often accompanied by unpleasant sensations that worsen during rest and at night. Among patients receiving peritoneal dialysis (PD), RLS is common yet frequently under-recognised, causing significant sleep disruption and reduced quality of life. Kidney transplantation is often assumed to resolve uremic symptoms, but RLS may persist or recur despite restored renal function.
Case Description:
A 40-year-old male on peritoneal dialysis for four years presented with severe, treatment-resistant restless legs syndrome (RLS). He reported classic lower limb discomfort with frequent involuntary upper body twitching, causing significant sleep disturbance. Multiple pharmacological therapies had been attempted with minimal benefit. The patient had previously undergone kidney transplantation, which provided temporary relief for a few months; however, his RLS recurred, showing transplantation does not guarantee sustained symptom improvement. The severity of his symptoms ultimately forced him to resign from work, highlighting the profound impact on his daily functioning and quality of life.
Discussion:
RLS in dialysis patients may involve iron deficiency, dopaminergic dysfunction, and central nervous system changes not corrected by transplantation. While first-line management includes addressing reversible factors and pharmacologic therapy, some patients remain highly symptomatic. This case underscores the need for ongoing assessment and proactive management to minimise symptom burden.
Conclusion:
Severe RLS can extend beyond the legs and persist or recur despite kidney transplantation and standard therapies. Proactive management is essential to improve sleep, daily functioning, and overall wellbeing in patients receiving peritoneal dialysis