Objective:

To evaluate the efficacy and safety of pharmacological therapies, including Traditional Chinese Medicine (TCM), for Restless Legs Syndrome (RLS) in adults undergoing hemodialysis, with a focus on both Western and TCM treatments.

Key Findings:

• Pharmacologic therapy significantly improved IRLS scores (MD –7.84) based on nine studies, sleep quality (SMD –0.82) from the same studies, and quality of life (SMD 0.48).
• Gabapentinoids showed the largest symptom reductions, followed by dopaminergic agents and iron therapy, based on the quantitative analysis.
• No treatment affected dialysis adequacy.
• Adverse events increased modestly (RR 1.28), highest with dopaminergic agents, as reported in the studies.

Interpretation:

Western pharmacologic agents, especially gabapentinoids, are effective for managing RLS in hemodialysis patients, though dopaminergic agents carry higher risks of adverse events.

Limitations:

• No TCM-related studies met inclusion criteria for quantitative evaluation due to lack of standardized RLS diagnosis, inconsistent outcome reporting, or mixed non-pharmacologic interventions.
• The study's findings may not be generalizable beyond hemodialysis patients due to the specific nature of the included studies.

Conclusion:

Gabapentinoids are effective for RLS management in hemodialysis patients, while TCM requires further rigorous trials to assess its efficacy and safety, highlighting the need for high-quality research.