C3G and Restless Legs Syndrome: Why It Happens and Tips for Relief

What Is Restless Legs Syndrome?

Why C3G Increases Your Risk of RLS

Several changes that occur with chronic kidney disease may contribute. These include low iron, abnormal electrolyte levels, medication effects, and waste buildup when the kidneys can’t filter the blood effectively, says Stefanie Diaz, MD, a board-certified nephrologist and a member of the teaching faculty at the University of Texas in Tyler, Texas.

Low Iron Can Affect the Brain

Waste and Mineral Changes May Affect the Nerves

As kidney function declines, waste products that the kidneys normally remove can accumulate in the blood, Dr. Diaz says. This condition, called uremia, may affect the nerves and muscles and contribute to RLS symptoms, notes Kuljeet K. Gill, MD, a sleep medicine specialist and neurologist at Northwestern Medicine in Winfield, Illinois, and a clinical assistant professor at the Feinberg School of Medicine.

Changes in electrolyte levels, nerve damage, and certain medications may also contribute to or worsen RLS symptoms, Dr. Soffler says.

Tips for Managing RLS With C3G

Always talk with your kidney care team before making changes to exercise, fluids, supplements, or medications, since what’s appropriate can depend on your kidney function and other health needs.

Review Your Medications and Supplements

A first step for managing restless legs with C3G is to take a look at the medications and supplements you use. Soffler recommends checking the active-ingredient label on over-the-counter sleep aids and allergy medicines. Some nighttime products, including certain medications labeled “PM,” contain diphenhydramine (commonly known as Benadryl), an antihistamine that may worsen RLS symptoms, she says.

Some prescription medications can also worsen RLS. Ask your doctor or pharmacist to review your prescription drugs, over-the-counter products, and supplements, but don’t stop or change a medication without medical guidance.

Note: The U.S. Food and Drug Administration does not approve supplements for safety or effectiveness. Talk to a healthcare professional about whether a supplement is the right fit for your individual health, and about any potential drug interactions or safety concerns.

Move, Stretch, or Massage Your Legs

Exercise Regularly

Cut Back on Possible Triggers

Make one adjustment at a time and notice how your legs feel. Keeping a log can help you identify patterns. Record the change you made, when your symptoms started, and whether they felt better or worse than usual afterward.

Keep a Consistent Sleep Routine

Follow Your Kidney Care Team’s Fluid Plan

If you suspect that dehydration may be contributing to RLS, talk to your nephrologist about whether your current fluid target should be adjusted.

Medical Treatments for RLS With C3G

In some cases, lifestyle tweaks and home remedies aren’t enough to get you through the night. Medical treatment for RLS is available, but before prescribing any, your doctor will generally confirm that the discomfort is truly caused by RLS, Soffler says. Leg cramps, nerve damage, and swelling, which can occur when you have kidney disease, can all create similar sensations, she notes.

Checking for RLS often involves blood tests to measure how much iron your body has stored and available, Gill says. Your doctor may also check your red blood cell count, kidney function, calcium, phosphorus, and other mineral levels, she adds.

A sleep study isn’t usually needed to diagnose RLS, but if you have signs of sleep apnea, Gill says that your care team may recommend one because treating sleep apnea may also relieve RLS symptoms.

With C3G, any RLS treatment needs to fit into the broader plan for protecting your kidney function. Some RLS medications are removed from the bloodstream by the kidneys, Soffler says, and your doctor may need to adjust the drug, dose, or timing because those medications can build up in the body when kidney function is reduced.

Depending on what your evaluation shows, RLS treatment when you have C3G may include:

• Iron Replacement If your iron stores are low, replacing the missing iron is usually the first step, Soffler says. Oral iron may be an option, though the preferred method for people receiving hemodialysis is iron given through a vein, she says. Restoring iron levels can improve RLS considerably or even make the symptoms go away.

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• Gabapentin and Similar Medications “Medications like gabapentin [Neurontin] or pregabalin [Lyrica] are now a go-to choice for RLS, though they need careful dosing, since the kidneys clear them,” Soffler notes. Gabapentin, gabapentin enacarbil (Horizant), and pregabalin can reduce the uncomfortable sensations and urge to move, while also improving sleep.

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  Possible side effects of these medications include sleepiness, dizziness, and unsteadiness.

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• Dopamine Medications These include pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro), which can relieve RLS, but doctors no longer use them routinely as a first choice.

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  Long-term use of these medications may cause augmentation, meaning RLS symptoms begin earlier in the day, feel more intense, return more quickly during periods of rest, or spread to the arms or other parts of the body. These medications may still be considered in certain situations, with close monitoring.
• Wearable Nerve Stimulation If medication hasn’t provided enough relief, Gill says that a prescription wearable nerve stimulator is a possible option. This wearable device sits just below the knees and sends mild electrical pulses to nerves along the outside of the lower legs during scheduled sessions.

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  The stimulation sends signals similar to those produced during movement, which may reduce RLS symptoms.
• Low-Dose Opioids for Severe RLS A sleep specialist may consider a low-dose opioid, such as extended-release oxycodone, to help with difficult-to-treat RLS, Soffler says. These medications can cause dependence, sleepiness, and slowed breathing, and they are reserved for select cases.

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  Kidney function status also determines whether they’re appropriate.

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• Options During Dialysis If C3G has progressed to kidney failure, treatment may also involve your dialysis team. Soffler says that vitamin C and supervised exercise during dialysis may help some people. The evidence is limited, and your body may not be able to remove extra amounts of vitamin C when you have reduced kidney function, so don’t take a supplement without your nephrologist’s approval.

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Soffler and Gill note that RLS can improve considerably or even resolve after a successful kidney transplant, though transplants are performed to treat kidney failure, not RLS specifically.

Keep your nephrologist, primary care doctor, sleep specialist, and other healthcare providers on the same page to help ensure that a treatment for one health problem doesn’t create issues elsewhere in your care.

When to Call Your Doctor

Many people with kidney disease assume that RLS is simply another symptom they have to live with. “There’s a lot we can do to help,” says Soffler.

Soffler recommends reaching out to a healthcare provider if:

• Your symptoms occur more than a couple of times a week and keep you from sleeping.
• You feel tired or drained during the day.
• The symptoms start to happen earlier in the day.
• The sensations spread to your arms.
• You develop numbness, pain, or weakness in your legs.
• The symptoms started or got worse after you began a new medication.