Actualización sobre el uso de hierro intravenoso para el tratamiento del síndrome de piernas inquietas asociado a insuficiencia renal terminal

Background: Restless legs syndrome (RLS) has been linked with perturbations in iron handling and is commonly acquired in patients with renal failure receiving long-term hemodialysis. Given the relationship between iron and RLS, we sought to determine whether intravenous (IV) iron dextran would improve symptoms of RLS in this population. Materials, methods and results: Patients with end stage renal disease (ESRD) on hemodialysis (HD) with RLS were enrolled in a double-blind, placebo controlled study comparing 1 000 mg of IV iron dextran against normal saline IV. Patient demographic data, blood testing (including serum iron, ferritin levels, and total iron binding capacity), side effect profiles and RLS severity scores were followed at 1, 2 and 4 weeks post infusion. At baseline, aggregate RLS scores were slightly more severe for the fourteen patients in the placebo group compared to the eleven patients randomized to receive iron dextran. Significant improvements in the RLS severity score were observed in the iron dextran-treated group one week after infusion, but peaked at two weeks becoming non-significant by week four. This correlated with increases in serum ferritin levels and iron saturation in the iron dextran-treated group. No differences in adverse events were appreciated in the two groups. Conclusions: High-dose, intravenous iron dextran significantly alleviated RLS in patients with ESRD, but salutary effects are transient.