Abstract: Objective   To conduct a meta-analysis on the incidence and risk factors of restless legs syndrome (RLS) in patients undergoing maintenance hemodialysis (MHD).  Methods  We searched the databases including PubMed, Web of Science, EMbase, the Cochrane Library, SinoMed, CNKI, Wanfang Data, and VIP from inception of the databases to December 2024. Stata 17.0 statistical software was employed for the meta-analysis.  Results  A total of 43 studies were included, with a total sample size of 12,333 patients among whom 2,519 were diagnosed with RLS. Twelve risk factors were identified. Meta-analysis revealed that the incidence of RLS in MHD patients was 24.8% (95% CI:21.1～28.5%). Risk factors for RLS included female gender (OR=1.332, 95% CI:1.231～1.441, P＜0.001), duration of dialysis (OR=1.037, 95% CI: 1.014～1.060, P=0.001), β2-microglobulin (OR=1.160, 95% CI:1.019～1.320, P=0.025), serum phosphorus (OR=1.591, 95% CI: 1.238～2.044, P＜0.001) and serum homocysteine (OR=1.252, 95% CI: 1.135～1.381, P＜0.001). High level of serum vitamin D (OR=0.909, 95% CI: 0.831～0.995, P=0.038) was a protective factor.  Conclusion  The incidence of RLS is relatively high in MHD patients. Healthcare professionals should identify RLS early based on risk factors and implement corresponding preventive measures and intervention strategies to reduce the incidence of RLS to improve patients' quality of life.

Key words: Maintenance hemodialysis, Restless legs syndrome, Incidence rate, Risk factor