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The following is a summary of “Treatment of insomnia, restless legs, cramps, and pain associated with chronic kidney disease: results from a multinational survey of kidney supportive care practice,” published in the April 2025 issue of BMC Nephrology by Nalankilli et al. 

Researchers conducted a prospective study examining the symptom burden in patients with kidney failure. Few studies describe real-world management approaches for these symptoms. 

They surveyed kidney care units in Australia, New Zealand (NZ), and the United Kingdom (UK) regarding pharmacological treatment of common symptoms in kidney failure. Variation in responses was described using normalized generalized variance (NGV), with scores ranging from 1 (most diverse) to 0 (least diverse). 

The results showed that 112 of 171 contacted kidney units responded, including 56 units in Australia (50%), 7 in NZ (6%), and 49 in the UK (44%). The diversity of practice was highest for insomnia (mean NGV 0.95, range 0.93–0.98), with melatonin as the leading first-line agent (38%). The lowest diversity was for restless legs syndrome (RLS) (mean NGV 0.66, range 0.30–0.99), with iron replacement (69%), gabapentinoids (45%), and dopamine agonists (37%) as common treatments. Diversity for neuropathic pain was moderate (mean NGV 0.71, range 0.44–0.93), as was for cramps (mean NGV 0.72, range 0.48–0.97) and opioids (mean NGV 0.88, range 0.75–0.97). Significant between-country differences were noted. 

Investigators found a wide variation in treatment approaches to common symptoms in advanced chronic kidney disease (CKD), both within and between countries, highlighting the need for evidence-based guidelines and further randomized studies. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-04107-1