Iron deficiency (ID) is a prevalent complication of chronic kidney disease (CKD), often managed reactively when associated with anaemia. This scoping review evaluates the evidence supporting intravenous (IV) iron therapy in non-anaemic individuals with CKD and ID, focusing on safety, efficacy, and emerging therapeutic implications. Current diagnostic markers, including serum ferritin, transferrin saturation, and reticulocyte haemoglobin content, are reviewed alongside their limitations in the context of inflammation and variability. The pathophysiology of ID in CKD is explored, highlighting the roles of hepcidin, hypoxia-inducible factor pathways, and uraemic toxins. Comparative studies reveal that IV iron offers a more rapid correction of iron stores, improved compliance, and fewer gastrointestinal side effects compared to oral iron. Evidence from trials such as "iron and heart" and "iron and muscle" suggests potential benefits of IV iron on functional capacity and fatigue, though findings were statistically non-significant. Insights from heart failure trials support the safety and efficacy of IV iron in improving quality of life and reducing hospitalizations, with newer formulations like ferric derisomaltose demonstrating favourable safety profiles. This review underscores the need for standardized screening protocols for ID in CKD, even in the absence of anaemia, to facilitate earlier intervention. Future research should prioritise robust outcome measures, larger sample sizes, and person-specific treatment strategies to optimise dosing and administration frequency. Tailored approaches to IV iron therapy have the potential to significantly improve functional outcomes, quality of life, and long-term health in people with CKD.

Sleep disorders are highly prevalent in patients with chronic kidney disease (CKD) but are often under-recognized. The most common sleep disturbances in people with CKD include insomnia, sleep apnea syndrome, restless leg syndrome, and periodic limb movement disorder. The presence of sleep disorders in CKD can further worsen the burden of high morbidity and mortality in a patient population with already high mortality rates. The detection and management of sleep disorders in patients with CKD are often challenging since the classic symptoms of sleep disorders (poor concentration, daytime sleepiness, and insomnia) overlap with CKD symptomatology. The treatment of one symptom may have a negative impact on others; hence treatment of these disorders is challenging and may need to be individualized and modified based on the response to treatment and the development of adverse effects. However, treatment of sleep disorders may have significant clinical benefits leading to improved health-related quality of life. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiology, diagnosis and treatment strategies.

This study aimed to review massage, acupressure and reflexology interventions applied to haemodialysis patients with restless legs syndrome and to examine the effects of these interventions on sleep quality.

A systematic review and meta-analysis.

A systematic literature search was conducted on databases ScienceDirect, Web of Science, Cochrane Central Register of Controlled Trials, EBSCO and PubMed.

The Modified Jadad scale was used. The statistical analysis was conducted using the Stata 15.0 software, with the aim of evaluating heterogeneity between studies using both chi-square and I2 statistics. The risk of bias in the included studies was assessed using both the Cochrane risk of bias assessment tool and statistical tests. A funnel plot was used to detect potential publication bias, which is indicated by an asymmetry in the plot. The Egger regression test was also performed to evaluate publication bias.

Twelve studies were selected for the meta-analysis. All studies included in this meta-analysis were of good quality. In the subgroup analysis, it was determined that massage and acupressure reduced the severity of restless legs syndrome as a result of the intervention, while reflexology had no effect. Interventions did not affect the sleep quality of patients. Restless legs syndrome severity was significantly reduced in studies using oil and in studies that intervened for more than 15 min per session.

Interventions applied to haemodialysis patients with restless legs syndrome can reduce the severity of restless legs syndrome. It is recommended to conduct randomised controlled trials that determine the effects of methods on restless legs syndrome severity and sleep quality in haemodialysis patients.

Whether restless legs syndrome (RLS) and sleep disturbance (SD) in hemodialysis (HD) patients influence all-cause and cardiovascular mortality remains controversial. The aim of this study was to evaluate the association between RLS or SD and 3-year mortality in HD patients.

A total of 301 patients who underwent HD were examined in April 2021 and were followed up for 3 years. The median follow-up time was 36.0 [33.3, 36.0] months. Fifty-four patients fulfilled the diagnosis of RLS (17.9%), 126 patients complained of SD (41.9%). Demographic parameters, clinical features, laboratory indices, and two questionnaires to assess the diagnosis of RLS and sleep status were collected. All-cause mortality and cardiovascular mortality in this population were evaluated. Cox regression analyses and Kaplan-Meier curves were performed to determine the effect of RLS or SD on 3-year mortality.

The RLS group reported that 29 patients (53.8%) exhibited concurrent symptoms of SD. The presence of RLS or SD alone did not significantly elevate the risk of all-cause mortality (p = 0.053 and p = 0.193). However, the coexistence of RLS and SD was identified as an independent risk factor for all-cause mortality (p = 0.011). Furthermore, the various combinations associated with RLS or SD were found to be independently correlated with the risk of cardiovascular death (p < 0.05).

The combination of RLS and SD in HD patients is associated with an increased risk of cardiovascular and all-cause mortality, underscoring the clinical significance of this association.

Objectives: The aim of this study is to compare data from two cohorts separated by a 17-year interval. We assessed the prevalence and severity of symptoms with the "dialysis symptom index" in these two groups, recruited in 2007 and 2024, to determine how advancements in dialysis therapy have influenced the symptom burden's prevalence and severity. Methods: End-stage renal diseases patients receiving maintenance hemodialysis three times a week in the hemodialysis unit of the university hospital were recruited between February and March 2007. In May 2024, in the same unit, another population sample was recruited and studied, as in 2007. The Dialysis Symptom Index (DSI) was administered to each patient, during the dialysis treatment. The DSI is made up of 30 questions, each of which addresses a specific physical or emotional symptom. The total symptom burden score, representing the total number of symptoms reported as being present, and the total symptom severity score, which represents the sum of individual severity scores, were generated for each patient. Results: We studied 71 patients in 2007 and 61 patients in 2024. The demographic, clinical and laboratory characteristics of the two study populations did not differ significantly. The total symptom burden score did not differ significantly between 2007 and 2024. The prevalence of most symptoms was similar in the two groups. The prevalence of constipation, decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. The total symptom severity was similar in the two periods. The severity of most symptoms was similar in the two groups. The severity of decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. Conclusions: The present study shows that, 17 years apart, the prevalence and severity of the symptom burden in patients on maintenance hemodialysis did not change significantly. These results suggest that studies investigating the causes and the pathogenesis of symptoms of patients on maintenance hemodialysis are urgently needed in the next future, as well as studies on therapeutic strategies.

Sleep disturbance has been studied in adult patients with early and end-stage chronic kidney disease (CKD). However, there are limited publications on the pediatric patient population. This paper evaluated the association between sleep disturbances and quality of life (QoL) in pediatric patients with CKD.

 The study included 22 patients and 22 healthy controls from the pediatric nephrology outpatient clinic. All participants completed the Turkish Generic Health-Related Quality of Life Questionnaire for Children and Adolescents (HRQoLQ) and the Child Sleep Habits Questionnaire (CSHQ). Patients diagnosed with CKD were compared in terms of HRQoLQ and CSHQ scores within themselves as kidney replacement therapy (KRT) recipients and non-recipients and with the control group.

The mean HRQoLQ total score of the patients was 89.0 ± 12.4 and the mean CSHQ total score was 46.7 ± 5.6; there was no correlation between the total scores (p=0.599). CSHQ total and subgroup scores were similar in patients with and without KRT. The CSHQ total and subgroup median scores were not different in the patient and control groups. According to the HRQoL scale, the total QoL score and the physical and emotional well-being subscale scores were lower in patients receiving KRT than in those not receiving KRT.

Sleep problems and HRQoL should not be underestimated in the pediatric CKD population, especially in patients receiving KRT. Large-scale studies with long-term outcomes are needed to understand better and improve QoL.

Patients having COPD share some factors, e.g., chronic hypoxemia, anemia of chronic disease and nicotine use, which are also the risk factors for RLS hence predispose them to experience RLS in higher then general population. There are limited studies with methodological constraints evaluating the prevalence and/or correlates of RLS among patients with COPD.

Consecutive adult patients of either gender, having stable COPD as per GOLD guidelines 2021, were assessed for RLS using IRLSSG (2014) criteria (excluding RLS mimics) and the severity of RLS was determined in participants having RLS. Phenomenology of RLS, past medical history and laboratory parameters were gathered. Insomnia and depression were assessed using the insomnia severity index and PHQ-9, respectively.

Participants' (N = 210) mean age was 63.02 ± 8.19 years, and 83.8% of subjects were men. 12.9% of participants were found to have RLS. Among those having RLS, nearly half (51.9%) had moderate symptoms, and 18.5% experienced severe symptoms. RLS was more prevalent among younger, females, those having severe COPD, participants having exacerbation of COPD in the previous year, lower post-bronchodilator FEV1, higher dyspnea and COPD assessment test score. Multivariate analysis showed that younger age, female gender, lower post-bronchodilator FEV1, lower FEV1/FVC ratio and higher serum creatinine increased the odds of having RLS. Depressive symptoms were more frequent in participants having RLS.

The present study found that the prevalence of RLS among patients with stable COPD was higher than the general population. Female gender, younger age, higher airflow limitation and higher serum creatinine (though in the physiological range) increase the odds of having RLS. Stable patients with COPD having these characteristics must be screened for RLS.

To investigate the correlation among sleep disorders, physical frailty, and depression in elderly patients with chronic kidney disease (CKD), and to explore the mediating role of depression.

This was a cross-sectional study, simple sampling was used to investigate the elderly CKD patients from one tertiary hospital in Shanghai. Those CKD patients who were diagnosed as CKD1-5 phase and were admitted to the Renal Medicine Ward from January to June 2022 and provided formal consent were considered for inclusion in our study. They were investigated with frailty phenotype (FP), Pittsburgh sleep quality index (PSQI), Center for Epidemiological Studies Depression Scale (CES-D), and self-made general information questionnaire. Linear regression was used to assess the associations between the variables, before this, PROCESS v4.1 was used to transform PSQI, CES-D and FP score to improve its normality, and conduct intermediary analysis. A difference of p < 0.05 was statistically significant.

A total of 504 elderly patients with CKD completed the questionnaire survey, aged 60-91. The incidence of sleep disorders among elderly patients with CKD was 60%, and the incidence of physical frailty was 18%. The depression was positively correlated with physical frailty (r = 0.418, p < 0.01) and sleep disorders (r = 0.541, p < 0.01). Physical frailty was positively correlated with sleep disorders (r = 0.320, p < 0.01). The depression plays a significant mediating role in the model, and the effect ratio of depression is 52%.

Depression is a mediating variable between sleep disorders and frailty. Improving depression in elderly patients with CKD accompanied by sleep disorders can help delay the occurrence of frailty.

Sleep quality is among the common complication in patients on dialysis and serious affect their health and quality of life; however, other associated risk factors are unclear. This study aimed to investigate the risk factors affecting sleep quality in patients on dialysis. Data were collected from 260 patients who met the inclusion criteria at out hospital from May 2023 to October 2023. Questionnaires were completed by patients, and biochemical indicators were obtained from past medical records. Univariate and multifactor analyses were used to find factors influencing sleep quality in patients on dialysis. Simple linear regression results showed that female, type of kidney primary disease, high systolic blood pressure (SBP), pruritus, pruritus frequency, restless legs syndrome (RLS), anxiety, and depression were associated with poor sleep quality. Blood biochemical parameters showed that low sodium and calcium levels and high ferritin levels were associated with poor sleep quality. Multiple linear regression statistics showed that female, pruritus, RLS, high SBP, depression, and high ferritin levels were associated with poor sleep quality. This study showed that female, chronic nephritis syndrome, high SBP, pruritus, RLS, low mood. and high ferritin levels were associated with poor sleep quality. Future development of individual nursing and targeted therapies is key to improving sleep quality in patients on dialysis.

Background and Objectives: Chronic kidney disease (CKD) is a global public health issue with rising incidence linked to substantial morbidity and mortality. Selenium, an antioxidant trace element, has been linked to low serum levels in end-stage renal disease. Restless Leg Syndrome (RLS), a sleep disorder, is prevalent in CKD patients and significantly impacts their quality of life. The objective of this study was to examine the correlation between serum selenium levels and the prevalence of restless leg syndrome in individuals with chronic kidney disease. Materials and Methods: Forty-six CKD patients undergoing serum selenium level assessments between 1 January 2020 and 28 February 2022, at the Hitit University Faculty of Medicine Department of Nephrology Outpatient Clinic or Hemodialysis Unit, were included. Patients over 18 years of age with no history of hematological or oncological diseases or acute or chronic inflammatory conditions were included in the study groups. Patients taking selenium supplements were excluded. Demographic data, comorbidities, and laboratory values were collected, and RLS presence and severity were evaluated. Statistical analyses include descriptive statistics, correlation analysis, the Mann-Whitney U test, Student's t test, and Chi-square test. Results: Among the 46 patients, 16 (34.78%) had RLS symptoms. The patient group included 34.78% predialysis, 34.78% peritoneal dialysis, and 30.44% hemodialysis patients, with a median age of 47.98 years. There was no difference in age, gender, and Charlson comorbidity between patients with or without RLS (p = 0.881, p = 0.702, p = 0.650). RLS prevalence varied across CKD subgroups, with hemodialysis patients having a higher prevalence (p = 0.036). Clinical parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, platelet counts, and parathyroid hormone levels exhibited significant differences between patients with and without RLS (p < 0.05). Serum selenium levels were not significantly different between patients with and without RLS (p = 0.327). Conclusions: With an increased comorbidity burden, CKD poses a significant healthcare challenge. When accompanied by RLS, this burden can be debilitating. The difference in CKD stages between groups has shed light on a critical determinant of RLS in this population, emphasizing the role of the chronic kidney disease stage. In our study, serum selenium levels were not associated with the presence and severity of RLS. However, prospective studies with larger numbers of participants are needed to draw a definitive conclusion.

Neurologic complications are a major contributor to death and disability in patients with renal disease. Oxidative stress, endothelial dysfunction, accelerated arteriosclerosis, and uremic inflammatory milieu affect both the central and peripheral nervous systems. This article reviews the unique contributions of renal impairment to neurologic disorders and their common clinical manifestations as the prevalence of renal disease increases in a globally aging population.

Advances in the understanding of the pathophysiologic interplay between the kidneys and brain, also referred to as the kidney-brain axis, have led to more widespread recognition of associated changes in neurovascular dynamics, central nervous system acidification, and uremia-associated endothelial dysfunction and inflammation in the central and peripheral nervous systems. Acute kidney injury increases mortality in acute brain injury to nearly 5 times that seen in matched controls. Renal impairment and its associated increased risks of intracerebral hemorrhage and accelerated cognitive decline are developing fields. Dialysis-associated neurovascular injury is increasingly recognized in both continuous and intermittent forms of renal replacement therapy, and treatment strategies for its prevention are evolving.

This article summarizes the effects of renal impairment on the central and peripheral nervous systems with special considerations in acute kidney injury, patients requiring dialysis, and conditions that affect both the renal and nervous systems.