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Do you sometimes feel an excruciating restlessness and tension in the legs - possibly also a pulling or even stinging sensation that doesn't let you sleep well at night? You are not alone in this! This is known as Restless Legs Syndrome (RLS) and it occurs frequently in connection with dialysis. Below you will learn what RLS is about, what the symptoms and causes are, and what options there are in therapy to counteract this.
Here's what you need to know
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Esto es lo que debe saber
  • Restless legs - known as uremic restless legs syndrome (RLS) in specialist circles - occur in a significant proportion of people on dialysis
  • Although often individual, typical symptoms include insomnia, an uncomfortable tingling or stinging sensation in the legs, and a strong urge to move around
  • Treatment options include iron replacement therapy, medications, exercise, dietary changes and alternative treatments - as always, it is best to discuss RLS with your dialysis team
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What exactly is restless legs syndrome? 

Restless legs are a disturbing symptom that can occur in connection with your kidney disease. Uremic restless legs syndrome (RLS) is particularly common in dialysis patients and can have a major impact on psychological well-being and overall quality of life. 

Uremia or uremic colloquially means "urine in the blood", i.e. the increased occurrence of urinary substances in the blood due to a lack of or insufficient kidney function.

Basically, the symptoms are individual and those affected usually find it difficult to describe their complaints. Nevertheless, there are characteristic features for uremic RLS: 

  • Do you often experience an uncomfortable feeling of tightness in your legs, which can sometimes result in tingling, tearing or stinging? Occasionally, your arms may possibly be affected as well.
  • Do you have a tremendous need to move or tense your leg muscles?
  • Do activity, massages or cold showers improve your symptoms, but the discomfort returns relatively quickly?
  • Do you find it difficult to fall asleep because the unpleasant restlessness often occurs at night and robs you of sleep? Are you often tired and exhausted during the day?

What are causes for Restless Legs Syndrome? 

Basically, it must be said that the exact causes for uremic RLS are not yet exactly clear. One aspect is the genetic predisposition of those affected, so part of it is based on your genetic makeup, your DNA. In addition, it is known that RLS is not caused by dialysis itself. Possible influencing factors can include iron deficiency, diabetes, vascular diseases, inflammations, sleep apnea (=breathing arrest during sleep), neurological diseases, and the degree of renal insufficiency. These factors also determine the course of uremic RLS. 

What helps with restless legs syndrome (RLS)? Possible therapeutic methods:

Although the causes are not yet clear, there are several treatment approaches that can relieve your symptoms. Whether you should choose a treatment depends on you individually, your symptoms and, of course, the opinion of your medical and dialysis team. Treatment options for uremic RLS can vary in nature. The most common ones are listed here:

Drug therapy 

One way to treat uremic RLS is through the use of medications, if prescribed by your medical team. For example, dopamine preparations are often used to improve communication between the nerve cells. Sometimes iron therapy via tablets or infusions is also used. However, you should always talk to your doctor to find out which medication is best suited for your dialysis treatment. 


You are what you eat! A dialysis- and kidney-friendly diet will not only help you improve your overall health and stay fit, but will also help alleviate the symptoms of your restless legs. A diet rich in iron and protein is recommended. The German Nutrition Society (DGE) recommends that adolescents and adults consume between 10 and 15 mg and children between 8 and 10 mg of iron per day to cover their daily iron requirement of about 1 mg. On dialysis, a daily intake of 1.2 to 1.4 grams of protein per kilogram of body weight is also recommended for adults.  

In addition, unless your nephrologist says otherwise, the basics of a dialysis-appropriate diet apply: a low-potassium, low-phosphate and low-salt diet, and adjusting the amount you drink. You can find recipes and general tips and tricks in your Mizu app. A good rule of thumb is to favor unprocessed produce, as it tends to contain less phosphate. In the Mizu app, the traffic light function of the phosphate-protein ratio in the food checker also helps you find foods that are beneficial for you. 

Physical exercise 

Regular exercise not only keeps you generally healthy and makes you happy but also helps you reduce your RLS symptoms. The important thing here is not to overdo it but also not to take it too easy. There are many options for moderate physical activity. Yoga, gymnastics, cycling or swimming are just a few of many examples. Pick something you enjoy and try it out! Be sure to get the appropriate recovery and rest to allow your body to benefit from the sessions.

What happens to Restless Legs Syndrome after a kidney transplant? 

After a kidney transplant, the symptoms of RLS usually disappear. However, a transplant naturally reflects the extreme case and, as you surely know, often does not go directly due to waiting times of several years. Therefore, the already mentioned therapy options on dialysis are extremely valuable.

What else helps?  

Reflex zone massage, aromatherapy massage, exercises on a recumbent bike or stretching exercises offer further possibilities to give your struggling legs some rest. Alternating showers or homeopathy may also help. What is certain is that uremic RLS can have a major negative impact on your quality of life and overall well-being. Talking to your doctor, nephrologist, friends and acquaintances can be very relieving and help you. Even in your dialysis center, you are certainly not the only person with RLS. Therefore, try to find out how others have dealt with this situation. They can best empathize with your situation and possibly support you.

Medically reviewed by:
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Verificato dal punto di vista medico da:
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No items found.
  • Deutsche Restless Legs Vereinigung. Abgerufen am 26.05.2022.
  • Restless Legs Syndrom. Abgerufen am 26.05.2022. 
  • Pino JMV, da Luz MHM, Antunes HKM, Giampá SQC, Martins VR, Lee KS. Iron-Restricted Diet Affects Brain Ferritin Levels, Dopamine Metabolism and Cellular Prion Protein in a Region-Specific Manner. Front Mol Neurosci. 2017 May 17;10:145. doi: 10.3389/fnmol.2017.00145.
  • Deutsche Gesellschaft für Ernährung (DGE) 
  • Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev. 2019 Jan 4;1(1):CD007834. doi: 10.1002/14651858.CD007834.pub3. PMID: 30609006; PMCID: PMC6353229.
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