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High pain burden seen in CKD, dialysis, and transplant patients

High pain burden seen in CKD, dialysis, and transplant patients

 


Pain is common in patients with stage 3 or higher chronic kidney disease (CKD), on dialysis, and in kidney transplant recipients.

In 116 studies and a systematic review and meta-analysis of 40,678 individuals, 60% had pain, 48% had chronic pain lasting more than 3 months, and 10% were neuropathic. I had a pain.Scotland and colleagues reported in Kidney International..

The overall prevalence of pain was lower among kidney transplant recipients (46%) compared to patients undergoing dialysis (63%) and patients with non-dialysis CKD (63%). Individuals undergoing hemodialysis and peritoneal dialysis had a similar prevalence of pain. Among patients with non-dialysis CKD, stage 3 or 4 patients reported pain as often as stage 5 patients, according to researchers. This is probably because these patients received palliative care.


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Neuropathic pain affected a higher proportion of patients with diabetes, hypertension, or high obesity index. Researchers said diabetes can cause diabetic neuropathy, hypertension can impair nerve conduction, and obesity can cause systemic inflammation and nerve damage.

Musculoskeletal pain was the most common pain symptom in patients with conservatively managed CKD (42%) or on dialysis (45%), but less common in kidney transplant recipients. It wasn’t (18%). Musculoskeletal pain, including bone and joint pain, may be associated with CKD-minerals such as secondary hyperparathyroidism and bone disorders (CKD-MBD), according to researchers. Fibromyalgia was significantly associated with old age.

Abdominal pain was most common in kidney transplant recipients (41%), but was less of a concern in patients with non-dialysis CKD (15%) and dialysis (16%). According to researchers, kidney transplant recipient abdominal pain may be associated with persistent postoperative pain. Visceral hyperalgesia; The inherent toxicity of immunosuppressive drugs (especially mycophenolates mofetil and sirolimus) causes mucosal damage, ulceration, diverticulosis and, in the worst case, perforation. Or there are a lot of daily medicines.

“Especially between the CKD non-dialysis subgroup and patients receiving dialysis treatment, the pain burden on CKD patients is high, enhancing the benefits of kidney transplantation for quality of life,” Dr. Bell’s team concludes. It was. “But the pain burden of kidney transplant recipients is not important. Comprehensive pain assessments should rely on validated measures. A group of patients whose quality of life has already changed due to chronic kidney disease. In order to reduce its prevalence and prevent unnecessary distress, it is essential to better recognize this common symptom. “

reference

Rambourg E, Corbin L, Guthrie G, etc. Prevalence of pain in patients with chronic kidney disease using systematic reviews and meta-analysis.. Kidney Int.. Published online on April 30, 2021. doi: 10.1016 / j.kint.2021.03.041

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