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Exploring factors associated with pain in hemodialysis patients: a multicenter cross-sectional study from Palestine
Maha K Marzouq1, Aseel F Samoudi1, Ahmad Samara1
1Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839, Nablus, Palestine.
Insights
Chronic pain affects over 66% of end-stage kidney disease (ESKD) patients undergoing hemodialysis (HD). Factors like female gender, higher BMI, and multiple comorbidities are linked to increased pain severity in these patients.
Area of Science:
- Nephrology
- Pain Management
- Public Health
Background:
- Chronic kidney disease (CKD) is a growing global health issue.
- End-stage kidney disease (ESKD) requires renal replacement therapy, most commonly hemodialysis (HD).
- Patients on HD experience higher mortality and morbidity than transplant recipients, highlighting the need to address associated complications like pain.
Purpose of the Study:
- To determine the prevalence of pain among ESKD patients undergoing HD in Palestine.
- To identify factors associated with pain severity in this patient population.
Main Methods:
- A multicenter, cross-sectional study was conducted in the West Bank, Palestine.
- Data was collected via direct interviews using a questionnaire, including the Brief Pain Inventory (BPI).
- 300 participants were enrolled using a convenience sampling technique.
Main Results:
- 66.3% of participants reported chronic pain.
- Hemodialysis sessions were the most common cause of pain (21.6%), with upper and lower limbs being the most frequent sites (37.3%).
- Higher BMI, female gender, and a greater number of comorbidities were independently associated with increased pain severity.
Conclusions:
- Chronic pain is highly prevalent in HD patients in Palestine.
- Females, patients with higher BMI, and those with multiple comorbidities represent subpopulations with greater pain severity.
- Routine pain assessment and proactive management strategies are crucial for improving clinical outcomes and reducing pain-related disability in HD patients.
Background:
Chronic kidney disease (CKD) is a rising medical concern around the world. End-stage kidney disease (ESKD) is the last stage of CKD stages that necessitates renal replacement therapy (RRT), such as hemodialysis (HD), which seems to be the most commonly used type. However, patients on HD still suffer from high mortality and morbidity rates compared to those who receive a kidney transplant. Therefore, we aimed in this study to assess the prevalence of pain among ESKD patients on HD, as well as to explore the factors that were associated with this complaint.
Methods:
We conducted a multicenter cross-sectional study in the West Bank, Palestine, between August and November 2018. We used questionnaire-based direct interviews with subjects. After reviewing previous studies in the field, we developed our questionnaire and included items on patients' social, demographic, and clinical characteristics, including dialysis-related data. It also contained the Brief Pain Inventory (BPI) to assess different aspects of pain symptoms. A convenience sampling technique was used to collect data.
Results:
Of the 300 participants, 66.3 % reported having chronic pain. HD sessions themselves were the most commonly cited cause for pain (21.6 %). The most commonly cited site of pain was the upper and lower limbs (37.3 %). Paracetamol was the most frequently used pharmacotherapy for pain alleviation. Multiple regression analysis showed that BMI (p = 0.018), gender (p = 0.023), and the number of comorbidities (p < 0.001) were independently associated with pain severity score.
Conclusions:
Pain is a highly prevalent symptom among HD patients in Palestine. Subpopulations with higher pain severity include females, patients with higher BMI, and those with multiple comorbidities. Healthcare providers should routinely assess pain in HD patients as it is considered a significant concern. This would involve pain assessment and development of a treatment plan to improve clinical outcomes. The nephrology associations should also push for pain management in HD patients as a clinical and research priority to improve pain-related disability.