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Kidney Week

Abstract: FR-PO909

Single Questions for the Diagnoses of Restless Legs Syndrome, Anxiety, and Depression in Hemodialysis (SQUIRREL)

Session Information

Category: Dialysis

  • 609 Dialysis: Palliative and End-of-Life Care


  • Collister, David Thomas, McMaster University, Hamilton, Ontario, Canada
  • Rodrigues, Jennifer C., McMaster University, Hamilton, Ontario, Canada
  • Mazzetti, Andrea Elisa, St. Joseph''s Healthcare Hamilton, Hamilton, Ontario, Canada
  • Salisbury, Kelsi, St. Joseph''s Healthcare Hamilton, Hamilton, Ontario, Canada
  • Morosin, Laura M, St. Joseph''s Healthcare Hamilton, Hamilton, Ontario, Canada
  • Brimble, K. Scott, McMaster University, Hamilton, Ontario, Canada
  • Walsh, Michael, McMaster University, Hamilton, Ontario, Canada

Symptoms in patients with kidney disease, such as restless leg syndrome (RLS), depression and anxiety, are common, reduce quality of life and are potentially treatable. Simple, accurate screening tools are needed. We examined the operating characteristics of the single questions for RLS, depression and anxiety from the revised Edmonton Symptom Assessment System (ESAS-r) in hemodialysis patients.


We conducted a cohort study of adults receiving chronic hemodialysis in Hamilton, Canada. Diagnoses of RLS, anxiety and depression were made using the 2012 IRLSSG criteria and the Hospital Anxiety and Depression Scale. Participants were asked to the degree to which they experienced restless legs, anxiety and depression using the ESAS-r 11-point scales anchored at 0 (no symptoms) and 10 (worst possible symptoms). ESAS-r single questions were compared to their reference standards using cutoffs greater than 0 indicating the presence of symptoms using logistic regression from which receiver operating characteristics (ROC) curves were generated.


We recruited 50 participants with a mean age of 64 (12.4) years, of whom 52% were male and 92% were on 3x weekly hemodialysis. Using the reference standards, 14 (28%) had a diagnosis of RLS, 27 (54%) had depression and 28 (56%) had anxiety. 27 (54%), 36 (72%) and 25 (50%) expressed symptoms of RLS, anxiety and depression. Areas under the ROC curves were 0.65, 0.81, 0.82 for RLS, anxiety and depression respectively (Figure 1). As a screening tool, an IRLS cutoff of 19 had the highest area under the ROC curve at 0.76 with a sensitivity of 71% and specificity of 81%.


The ESAS-r single question for RLS has poor discrimination for the diagnosis of RLS in a hemodialysis population although the ESAS-r single questions for anxiety, depression and the IRLS demonstrate reasonable discrimination.


  • Government Support - Non-U.S.