Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage

Pain assessment, management and impact among Hemodialysis patients: a study from Tunisia

INTRODUCTION

Pain is a common complication in patients with end-stage chronic kidney disease, impacting their quality of life. However, the pain experienced by dialysis patients is often overlooked in favor of other issues related to chronic kidney disease and dialysis itself. The study aimed to assess the prevalence, intensity, location, and impact of pain on daily activities in a cohort of chronic hemodialysis patients.

MATERIALS AND METHODS

We conducted a cross-sectional study during November and December 2023. Patients aged 18 years and older, undergoing hemodialysis for at least 6 months, completed an anonymous questionnaire. Socio-demographic and clinical characteristics of the patients were recorded initially, and pain aspects were evaluated using the Brief Pain Inventory.

RESULTS

Among the 100 patients surveyed, 78% reported suffering from chronic pain, considered moderate by 57.7% of them. Pain occurred in 89.7% of cases after hemodialysis sessions, was osteoarticular in 71.8% of cases, predominantly in the lower limbs in 94.9% of cases, of mixed type in 71.8% of cases, and caused partial functional impairment in 53.8% of cases. Paracetamol was the most commonly used analgesic (75% of cases).

CONCLUSION

This research confirms the high prevalence of pain among chronic hemodialysis patients and its negative impact on them. Healthcare providers should consistently evaluate pain in dialysis patients. Pain management should be a research priority because pain is a valid and considerable health concern in the increasing chronic kidney disease patient population.

Chronic Pain Characteristics and Interference With Daily Activities in Patients Undergoing Hemodialysis: A Cross-Sectional Study

PURPOSE

Few studies have analyzed the characteristics of chronic pain and its functional interference. This study aims to measure the prevalence of pain and assess the intensity, location, treatments used and functional interference in the daily living of patients with chronic pain undergoing hemodialysis treatments in Morocco.

DESIGN

This research has a descriptive cross-sectional design METHODS: A multicenter study was performed in four public hemodialysis centers in Morocco's northern region including 174 patients undergoing hemodialysis. Sociodemographic, chronic pain and interference were evaluated through a structured questionnaire, the Visual Analog Scale and the Brief Pain Inventory.

RESULTS

Descriptive statistics were applied to data analysis. The prevalence of chronic pain was 56.7%, severe in 50.6% of cases and 81.6% experienced continuous pain. The most common pain locations among patients undergoing hemodialysis were the lower limbs 58.6%, back 41.4% and hips 36.4%. Therefore, a high prevalence of severe functional interference of pain has been found in walking 60.34%, general activities 52.87% and work 48.85%. Additionally, analgesics were used by 73.6% of patients, with 46.1% of instances involving frequent use and relief for 32.81%.

CONCLUSIONS

Chronic pain is prevalent, undertreated and localized in the lower limbs, back and hips, leading to severe interference with functional activities.

CLINICAL IMPLICATIONS

This evidence makes professionals aware of their patient's pain and its impact, and consequently, their assessment must be conducted in a primordial and regular manner to improve management. Pain management can be based on pharmacological approaches such as opioids as well as nonpharmacological approaches.

Clinical and ultrasonographic features of 104 knee joints in hemodialysis patients: impact of age, gender, and hemodialysis duration: a descriptive cross-sectional study

BACKGROUND AND OBJECTIVES

Hemodialysis (HD) patients struggle with musculoskeletal disorders. This study aimed to examine knee clinical and musculoskeletal ultrasonographic (MSUS) characteristics in HD patients and to evaluate the influence of age, gender, and HD duration.

MATERIALS AND METHODS

This cross-sectional descriptive study included 52 patients (104 knee joints) on regular HD for at least 6 months. Demographic, clinical, therapeutic, and laboratory data were collected. Chronic knee pain was assessed for duration, intensity, and laterality. Swelling, crepitus, and tenderness were assessed in both knees. EULAR-standardized knee MSUS evaluations were performed on all patients. The patients were then compared based on age, gender, and HD duration.

RESULTS

The mean age of the patients was 52.4 ± 14.15 years, with 25 females and 27 males, median duration of HD was 3.5 years. Chronic knee pain was present in 31 of 104 knees (29.8%). The scanned 104 knee joints had at least one MSUS finding in 91 (87.5%): suprapatellar effusion in 57 (54.8%), synovial thickening in 13 (12.5%), abnormal cartilage morphology in 68 (65.4%), quadriceps tendon abnormalities in 58 (55.8%), patellar tendon abnormalities in 34 (32.7), medial meniscus abnormalities in 30 (28.8%), lateral meniscus abnormalities in 13 (12.5%), and Baker cyst in 5 (4.8%). MSUS abnormalities were significantly more prevalent in HD patients older than 40 years (94.9% vs. 65.4; p < 0.001). Chronic Knee Pain was more prevalent in females than males (40% versus 20%, respectively). Regarding HD duration, quadriceps, and patellar tendons exhibited more MSUS abnormalities in patients with HD duration > 3 years (86.5% vs. 42.0% and 38.9% vs. 25%, respectively) compared to others.

CONCLUSION

MSUS findings of the knee are prevalent among HD patients, particularly those of female gender, older age, and longer duration of HD. These findings could be subclinical. Typically, the severity of suprapatellar effusion is related to additional structural abnormalities.

Bio-sociological and clinical factors of chronic pain and pain interference in patients undergoing hemodialysis: a cross-sectional study

BACKGROUND

End-stage kidney disease is an irreversible and incurable alteration of kidney function, requiring renal replacement therapy such as hemodialysis. Hemodialysis patients are one of the most symptomatic of all chronic kidney disease groups, including chronic pain. Overlooked, underestimated, and undermanaged, pain is associated with altered health-related quality of life. Therefore, this study aims to explore the biological, clinical, and social variables associated with chronic pain and its interference with hemodialysis patients.

METHODS

A cross-sectional study was conducted on Moroccan hemodialysis patients. A total of 307 patients participated in the study. Data collection was based on a structured questionnaire with sociodemographic, clinical, and dialysis variables. The Numeric Rating Scale and Brief Pain Inventory were used to assess pain characteristics.

RESULTS

Almost half of the hemodialysis had chronic pain, the mean pain severity and pain interference scores were 3.73 ± 3.59, and 22.89 ± 22.74 respectively. Multiple regression analysis revealed that gender (p = 0.022), number of comorbidities (p = 0.001), dialysis vintage (p < 0.001), number of pain sites (p < 0.001), and PTH level (p < 0.001) were associated with pain severity score. Older patients (p = 0.049), gender (p = 0.007), subjects with a number of comorbidities (p < 0.001), dialysis vintage (p < 0.001), number of pain sites (p < 0.001), and level of PTH (p < 0.001) were significantly associated with pain interference score.

CONCLUSIONS

The subgroups with increased pain severity were female hemodialysis, subjects living with multiple comorbid conditions, those with length dialysis vintage, a high number of painful sites, and increased PTH levels. Assessing and reducing pain intensity, pain interference, and its factors must be a priority for healthcare providers to manage pain and improve health-related quality of life.

Chronic Kidney Disease and Osteoarthritis: Current Understanding and Future Research Directions

Chronic kidney disease (CKD) is a significant public health concern. Osteoarthritis (OA), a common form of arthritis, has been shown to have a dramatically increased prevalence, particularly among individuals aged 40-50 and older, in the presence of CKD. Furthermore, CKD may exacerbate the progression and impact of OA. A survey study revealed that 53.9% of CKD patients undergoing long-term hemodialysis were diagnosed with OA. These findings underscore the potential association between CKD and OA. Uremic toxins, such as indoxyl sulfate, p-cresyl sulfate, transforming growth factor-β, and advanced glycation end-products, are regarded as potential risk factors in various CKD-related conditions, affecting bone and joint metabolism. However, whether these factors serve as a bridging mechanism between CKD and OA comorbidities, as well as their detailed roles in this context, remains unclear. Addressing the progression of OA in CKD patients and identifying effective treatment and prevention strategies is an urgent challenge that warrants immediate attention. This review focuses on describing and discussing the molecular pathological mechanisms underlying CKD-associated OA and the possible therapeutic strategies.

Prevalence of Knee Pain and Its Relation to Depression, Anxiety, and Health-Related Quality of Life Among Maintenance Hemodialysis Patients

Background/Objectives: Knee pain in hemodialysis (HD) patients might affect health-related quality of life (HRQoL) and may be related to anxiety and depressive symptoms. The aim of this study was to assess the prevalence of knee pain in chronic HD patients and to determine its relationship with anxiety, depression, and HRQoL, Methods: This multicenter cross-sectional study was carried out on chronic HD patients. Sociodemographic, clinical, and therapeutic data were collected. The Knee Pain Screening Tool (KNEST) was used to screen for knee pain. Patients with knee pain were instructed to complete the visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The patients also completed an Arabic-language version of the Hospital Anxiety and Depression Scale (HADS) and the Kidney Disease Quality of Life-36 (KDQOL-36™) questionnaire. Results: This study included 271 chronic HD patients; the median age was 51 (IQR 21) years, and most of them were males (59%). Of them, 158 had knee pain. Those with knee pain were more likely to have anxiety compared to those without (p = 0.002) and significantly lower scores on the symptom/problem (p = 0.03) and burden of kidney disease domains (p = 0.047) and the physical health (p < 0.001) and mental health components (p = 0.001). Furthermore, those with moderate to severe knee pain were more likely to experience anxiety (p = 0.001) and depression (p = 0.005) and have a lower physical health composite (PHC) than those with mild knee pain (p = 0.046). Conclusions: HD patients have a significant prevalence of knee pain that is usually associated with anxiety and leads to worse HRQoL than those without knee pain.

Predictors of functional status and disability among patients living with chronic kidney diseases at St Paul's hospital millennium medical college, Ethiopia: findings from a cross-sectional study

BACKGROUND

The rise in risk factors like obesity, hypertension, and diabetes mellitus has partly led to the increase in the number of patients affected by chronic kidney disease, affecting an estimated 843 million people, which is nearly 10% of the general population worldwide in 2017. Patients with CKD have an increased risk of functional difficulties and disability. This study aimed to assess the level of functional status and disability and its associated factors among patients with chronic kidney attending Saint Paul Hospital, Millennium Medical College, Addis Ababa, Ethiopia.

METHODS

An institution-based cross-sectional study was conducted with 302 enrolled study participants through systematic random sampling techniques. Face-to-face interviews and chart reviews were used to collect data using a semi-structured questionnaire adapted from works of literature. The Health Assessment Questionnaire Disability Index (HAQ-DI) was used to assess the functional status and disability of the participants. Data was entered into EPI info version 7 and exported to SPSS version 23 for analysis. Bivariate logistic regression analysis was employed with a p-value less than 0.25. Finally, those variables with a p-value less than 0.05 in multivariate analysis were taken as statistically significant.

RESULTS

A total of 219 (72.5%) CKD patients had moderate to severe functional limitation and disability (HAQ-Di > 0.5-3). Age > 50 years [AOR = 1.65; 95% CI (1.23, 3.15)], being at stage 2 and 3 CKD [AOR = 4.05; 95% CI (1.82, 9.21), being at stage 4 and 5 CKD [AOR = 2.47; 95% CI (1.87, 4.72)], and having MSK manifestations [AOR = 2.97; 95% CI (1.61, 5.55)] were significantly associated with functional status and disability.

CONCLUSION

The findings of this study suggest that CKD-associated functional disabilities are common. The advanced stage of CKD, higher age, and presence of musculoskeletal manifestations appear to be important variables predicting self-reported functional status. Healthcare professionals treating CKD shall be vigilant about the CKD-associated disability, the modifiable predictors, and interventions to limit the CKD-related disability.

Barriers and facilitators to using a clinical decision support tool for the management of osteoarthritis pain in patients undergoing hemodialysis: a qualitative study

BACKGROUND

While osteoarthritis is a significant issue within the hemodialysis population and contributes to reduced quality of life, pain related to osteoarthritis is poorly managed by healthcare professionals (HCPs) in hemodialysis settings due to the absence of clinical guidance applicable to this population. The purpose of this study was to explore the perceptions of HCPs on the barriers and facilitators to using a clinical decision support tool for osteoarthritis pain management in the hemodialysis setting.

METHODS

A qualitative descriptive study was conducted. Purposeful and snowball sampling techniques were used to recruit hemodialysis clinicians from academic and community settings across multiple Canadian provinces. One-to-one interviews were conducted with clinicians using a semi-structured, open ended interview guide informed by the Theoretical Domains Framework, a behavior change framework. A general inductive approach was applied to identify the main themes of barriers and facilitators.

RESULTS

A total of 11 interviews were completed with 3 nephrologists, 2 nurse practitioners and 6 pharmacists. Findings revealed 6 main barriers and facilitators related to the use of the clinical decision support tool. Alignment of the tool with practice roles emerged as a key barrier and facilitator. Other barriers included challenges related to the dialysis environment, varying levels of clinician comfort with pain medications, and limited applicability of the tool due to patient factors. An important facilitator was the intrinsic motivation among clinicians to use the tool.

CONCLUSIONS

Most participants across the included hemodialysis settings expressed satisfaction with the clinical decision support tool and acknowledged its overall potential for improving osteoarthritis pain management among patients on hemodialysis. Future implementation of the tool may be limited by existing roles and practices at different institutions. Increased collaboration among hemodialysis and primary care teams may promote uptake of the tool.

Patellar tendon biomechanical and morphologic properties and their relationship to serum clinical variables in persons with prediabetes and type 2 diabetes

Tendon biomechanical properties and fibril organization are altered in patients with diabetes compared to healthy individuals, yet few biomarkers have been associated with in vivo tendon properties. We investigated the relationships between in vivo imaging-based tendon properties, serum variables, and patient characteristics across healthy controls (n = 14, age: 45 ± 5 years, body mass index [BMI]: 24 ± 1, hemoglobin A1c [HbA1c]: 5.3 ± 0.1%), prediabetes (n = 14, age: 54 ± 5 years, BMI: 29 ± 2; HbA1c: 5.7 ± 0.1), and type 2 diabetes (n = 13, age: 55 ± 3 years, BMI: 33 ± 2, HbA1c: 6.7 ± 0.3). We used ultrasound speckle-tracking and measurements from magnetic resonance imaging (MRI) to estimate the patellar tendon in vivo tangent modulus. Analysis of plasma c-peptide, interleukin-1β (IL-1β), IL-6, IL-8, tumor necrosis factor-α (TNF-α), adiponectin, leptin, insulin-like growth factor 1 (IGF-1), and C-reactive protein (CRP) was completed. We built regression models incorporating statistically significant covariates and indicators for the clinically defined groups. We found that tendon cross-sectional area normalized to body weight (BWN CSA) and modulus were lower in patients with type 2 diabetes than in healthy controls (p < 0.05). Our regression analysis revealed that a model that included BMI, leptin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), age, and group explained ~70% of the variability in BWN CSA (R2 = 0.70, p < 0.001). For modulus, including the main effects LDL, groups, HbA1c, age, BMI, cholesterol, IGF-1, c-peptide, leptin, and IL-6, accounted for ~54% of the variability in modulus (R2 = 0.54, p < 0.05). While BWN CSA and modulus were lower in those with diabetes, group was a poor predicter of tendon properties when considering the selected covariates. These data highlight the multifactorial nature of tendon changes with diabetes and suggest that blood variables could be reliable predictors of tendon properties.

Is chronic kidney disease associated with osteoarthritis? The United States national health and nutrition examination survey 2011-2020

OBJECTIVE

Chronic kidney disease (CKD) and osteoarthritis (OA) represent two frequently seen disorders among the general population, and they share several similar risk factors. The present work focused on assessing the relation of CKD with OA.

METHODS

This cohort study included 26,280 eligible participants aged ≥ 20 years who had valid data on CKD and OA from the National Health and Nutrition Examination Survey (NHANES) 2011-2020. The association between CKD and OA was studied by logistic regression, adjusting for demographics, body mass index (BMI), socioeconomic factors, physical activity, ever smoking, alcohol using, diabetes status and hypertension status.

RESULTS

Among the participants of this study, 26.69% of OA patients had concurrent CKD, whereas this proportion was only 13.83% among non-OA patients.CKD was related to OA[OR:2.269 (95%CI:2.266-2.271), p < 0.01] and the relation was of significance [OR:1.031 (95%CI:1.030-1.033),p < 0.01] following adjustments. In subgroup analyses based on age, the relation between osteoarthritis and chronic kidney disease remained significant, and in the subgroup analyses based on gender the previously mentioned relation between OA and CKD showed opposite directions in men [OR:0.869(95%CI0.867-0.871), p < 0.01] and women [OR:1.178(95%CI1.177-1.180), p < 0.01].

CONCLUSIONS

In the present 10-year large-scale national-wide survey, OA is closely related to CKD, and women with OA showed a higher risk of developing CKD compared to men. This study suggests that the relationship between OA and CKD deserves further investigation, and we suggest that patients with OA need to pay extra attention to their own kidney health.

Development and Validation of a Treatment Algorithm for Osteoarthritis Pain Management in Patients With End-Stage Kidney Disease Undergoing Hemodialysis

Background

Although osteoarthritis is common in the hemodialysis population and leads to poor health outcomes, pain management is challenged by the absence of clinical guidance. A treatment algorithm was developed and validated to aid hemodialysis clinicians in managing osteoarthritis pain.

Objective

The objective was to develop and validate a treatment algorithm for managing osteoarthritis pain in patients undergoing hemodialysis.

Design

A validation study was conducted based on Lynn's method for content validation.

Setting

To develop and validate a treatment algorithm, interviews were conducted virtually by the primary researcher with clinicians from various institutions across the Greater Toronto and Hamilton Area in Ontario.

Patients

The treatment algorithm was developed and validated for the management of osteoarthritis pain in patients on hemodialysis. Patients were not involved in the development or validation of the tool.

Measurements

The algorithm was measured for content and face validity. Content validity was measured by calculating the content validity index of each component (I-CVI) of the algorithm and the overall scale validity index (S-CVI). Face validity was assessed by calculating the percentage of positive responses to the face validity statements.

Methods

A draft algorithm was developed based on literature searches and expert opinion and validated by interviewing nephrology and pain management clinicians. Through consecutive rounds of 1:1 interviews, content and face validity were assessed by asking participants to rate the relevance of each component of the algorithm and indicate their level of agreeability with a series of statements. Following each round, the I-CVI of the algorithm as well as the S-CVI was calculated and the percentage of positive responses to the statements was determined. The research team revised the algorithm in response to the findings. The final algorithm provides a stepwise approach to the non-pharmacologic and pharmacologic management of pain, including topical, oral, and opioid use.

Results

A total of 18 clinicians from 7 institutions across the Greater Toronto and Hamilton Area were interviewed (10 pharmacists, 5 nurse practitioners, and 3 physicians). The average S-CVI of the algorithm across all 3 rounds was 0.93. At least 78% of participants provided positive responses to the face validity statements.

Limitations

An algorithm was developed based on input from clinicians working in the province of Ontario, limiting the generalizability of the algorithm across provinces. In addition, the algorithm did not include the perspectives of primary care providers or patients/caregivers.

Conclusions

An algorithm for the management of osteoarthritis pain in the hemodialysis population was developed and validated through expert review to standardize practices and encourage clinicians to use evidence-based treatments and address the psychosocial symptoms of pain. As the algorithm possesses a high degree of content and face validity, it may improve osteoarthritis pain management among patients undergoing hemodialysis. Future research will assess the implementation of the algorithm across hemodialysis settings.

Symptom burden, fatigue, sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort: a single center experience from Egypt

BACKGROUND AND AIMS

Musculoskeletal disorders (MSDs) are commonly encountered in hemodialysis (HD) patients. However, the causes linked to these disorders are still partially defined. The aim of this study was to determine the frequency of MSDs and their relationship to a variety of clinico-social characteristics such as sleep quality, mood disorders, fatigue, and social support, in addition to the patients' clinical and therapeutic profile.

METHOD

The study included 94 patients on maintenance HD. Clinical and Sociodemographic data was gathered. To investigate the prevalence and trends of MSDs, the Nordic Musculoskeletal Questionnaire (NMQ-E) was employed. Patients completed the modified Edmonton Symptom Assessment System, Pittsburgh Sleep Quality Index (PSQI), multidimensional Fatigue Inventory (MFI-20), and Perceived Social Support from Family Scales. Univariate and multivariate regression analysis were used to assess the determinants of MSDs.

RESULTS

The patients' mean age was 49.73 and 59.6% were males. Seventy-two percent of patients were afflicted by MSDs. Knee pain (48.9%), low back pain (43.6%), shoulder pain (41.6%), hip/thigh pain (35.1%), and neck pains (35.1%) were the most reported MSD domains. Pain (p = 0.001), fatigue (p = 0.01), depression (p = 0.015), and anxiety (p = 0.003) scores were substantially higher in patients with MSDs. Furthermore, patients with MSDs engaged in less physical activity (p = 0.02) and perceived less social support (p = 0.029). Patients with MSDs had lower subjective sleep quality, daytime dysfunction domains, and global PSQI scores (p = 0.02, 0.031, 0.036, respectively). Female gender (p = 0.013), fatigue (p = 0.012), depression (p = 0.014), anxiety (p = 0.004), lower activity (p = 0.029), and PSQI score (0.027), use of erythropoiesis-stimulating agents (ESAs), antihypertensive drugs, calcium and Iron supplementation were all significantly associated with MSDs. At the multivariable regression model, administration of ESAs (p = 0.017) and pain score (p = 0.040) were the only independent variables associated with the outcome.

CONCLUSION

MSDs are quite common among HD patients. Female gender, pain, fatigue, depression, anxiety, reduced activity, poor sleep quality, and use of ESAs are all significantly associated with MSDs in HD patients. Patients with MSD perceived less social support compared to the other group. Patients treated with antihypertensive drugs, calcium and iron supplements were more likely to suffer MSDs.

Disease-modifying interactions between chronic kidney disease and osteoarthritis: a new comorbid mouse model

OBJECTIVE

The prevalence of comorbid chronic kidney disease (CKD) and osteoarthritis (OA) is increasing globally. While sharing common risk factors, the mechanism and consequences of concurrent CKD-OA are unclear. The aims of the study were to develop a preclinical comorbid model, and to investigate the disease-modifying interactions.

METHODS

Seventy (70) male 8-10 week-old C57BL/6 mice were subjected to 5/6 nephrectomy (5/6Nx)±destabilisation of medial meniscus (DMM) or sham surgery. OA pathology and CKD were assessed 12 weeks postinduction by blinded histology scoring, micro-CT, immunohistochemistry for osteoclast and matrix metalloproteinase (MMP)-13 activity, and serum analysis of bone metabolic markers.

RESULTS

The 5/6Nx model recapitulated characteristic features of CKD, with renal fibrosis and deranged serum alkaline phosphatase, calcium and phosphate. There was no histological evidence of cartilage pathology induced by 5/6Nx alone, however, synovial MMP-13 expression and subchondral bone osteoclastic activity were increased (p<0.05), with accompanying reductions (p<0.05) in subchondral trabecular bone, bone volume and mineral density. DMM significantly (p<0.05) increased tibiofemoral cartilage damage, subchondral bone sclerosis, marginal osteophytes and synovitis, in association with increased cartilage and synovial MMP-13. DMM alone induced (p<0.05) renal fibrosis, proteinuria and increased (p<0.05) 5/6Nx-induced serum urea. However, DMM in 5/6Nx-mice resulted in significantly reduced (p<0.05) cartilage pathology and marginal osteophyte development, in association with reduced subchondral bone volume and density, and inhibition of 5/6Nx-induced subchondral bone osteoclast activation.

CONCLUSION

This study assessed a world-first preclinical comorbid CKD-OA model. Our findings demonstrate significant bidirectional disease-modifying interaction between CKD and OA.

Pain in Hemodialysis Patients: Prevalence, Intensity, Location, and Functional Interference in Daily Activities

Although pain is a frequent complaint of patients with chronic kidney disease who undergo hemodialysis, few studies have assessed the functional interference of pain in activities of daily living (ADLs). Hence, the aim of this study was to evaluate the prevalence, location, intensity, and functional interference of pain in ADLs of chronic kidney disease patients undergoing hemodialysis and to estimate the association of specific pain sites with severe functional interference by pain in ADLs. This cross-sectional study included patients with chronic kidney disease undergoing hemodialysis. The prevalence, intensity, and functional interference of pain in ADLs were assessed using the brief pain inventory. Poisson regression was used to calculate the prevalence ratio. A total of 65 patients participated in the study. The overall prevalence of pain was 89.23%; the prevalence of headache was 18.46% and that of pain in the trunk was 55.38%, upper limbs was 35.38%, and lower limbs was 60.00%. The prevalence of moderate and severe pain at the time of hemodialysis was 13.85% and 21.54%, respectively. A high prevalence of severe functional interference of pain in general activity (61.54%), mobility (56.92%), and disposition (55.38%) was observed. Pain is a frequent complaint in patients undergoing hemodialysis, mainly musculoskeletal and intradialytic, and it interferes with ADLs and incapacitates the patient. Pain was highly prevalent in the upper and lower limbs and the trunk. Furthermore, a higher prevalence of severe pain at the time of hemodialysis and functional interference of pain, mainly in general activity, mobility, and disposition, were observed.

Musculoskeletal Disorders and Associated Factors Among Patients with Chronic Kidney Disease Attending at Saint Paul Hospital, Addis Ababa, Ethiopia

Background

Musculoskeletal disorders contributed from chronic kidney disease are increasing worldwide. Musculoskeletal disorders had a significant health burden and are leading causes of co-morbidities, disability and low productivity, which potentially affect individual's functional status and quality of life.

Purpose

The aim of this study was to assess the prevalence of musculoskeletal disorders and its associated factors among patients with chronic kidney attending in Saint Paul Hospital, Addis Ababa, Ethiopia.

Patients and Methods

An institution-based cross-sectional study was conducted on 302 enrolled study participants through systematic random sampling techniques. Face-to-face interview, physical examination and chart reviews were used to collect data using semi-structured questionnaire adapted from a standard Nordic Musculoskeletal Questionnaire and other literatures. Data were entered into Epi Info version 7 and exported to SPSS version 23 for analysis. Bivariate logistic regression analysis was employed with a p-value less than 0.25. Finally, those variables having a p-value less than 0.05 with 95% CI in multivariate analysis were taken as statistically significant.

Results

The prevalence of musculoskeletal disorders among CKD individuals was found to be 58.6% (95% CI; 53.0, 64.1). Being female (AOR = 0.49; 95% CI 0.26, 0.94), age between 40 and 49 (AOR = 3.34; 95% CI 1.07, 10.44), stage III (AOR = 0.24; 95% CI 0.06, 0.89) and stage IV (AOR = 0.24; 95% CI 0.06, 0.89) chronic kidney disease, having HTN (AOR = 7.47; 95% CI 3.47, 16.06), parathyroid hormone level ≥100 pg/mL (AOR = 0.43; 95% CI 0.21, 0.87), calcium level <8.4 mg/dl (AOR = 5.89; 95% CI 2.66, 13.56) and serum 25 hydroxy vitamin D level <20 ng/mL (AOR = 3.91; 95% CI 1.32, 11.56) were significantly associated with musculoskeletal disorders.

Conclusion

MSDs were shown to be moderately common in CKD patients. Female gender, age between 40 and 49 yrs, stage III and stage IV CKD, hypertension, higher PTH level, lower calcium level and lower vitamin D level were statistically significant in their association with musculoskeletal disorders.

Pain in Patients With Chronic Kidney Disease Undergoing Hemodialysis: A Systematic Review

AIMS

To assess the presence of pain, its location, intensity, and effects on the daily activities of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD).

PARTICIPANTS/SUBJECTS

Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD).

DESIGN

A systematic review.

METHODS

We carried out search for articles published until December 2020, including publications in Portuguese, English, and Spanish during the past 15 years (2005-2020), using the Embase, SciELO, PubMed, and Web of Science databases. The following information was collected: type of pain, pain treatment, pain assessment instrument, prevalence of pain, location, and influence of pain on quality of life.

RESULTS

Twenty-five studies were selected for a systematic review. These studies involved a total of 98,162 adult and elderly patients with CKD who were undergoing HD. There was a high prevalence of pain in patients with CKD on HD. The most frequent sites of pain were the head, back, bones, chest, and the upper and lower limbs. The presence of acute, chronic, neuropathic pain, and myalgia was also reported in the studies. In addition, there was a higher frequency of moderate and severe pain, which influenced daily activities, the ability to walk, mood, relationships with other people, sleep, and work in patients on dialysis.

CONCLUSIONS

The analyzed studies suggest that acute and chronic pain is a prevalent complaint in adults and elderly patients undergoing HD. There was a higher frequency of moderate and severe pain in different parts of the body, and pain interfered with everyday activities.

Factors associated with hip pain in end-stage renal disease patients on prevalent hemodialysis: a cross-sectional study

Background

Hemodialysis (HD) patients suffer from musculoskeletal disorders. The most reported musculoskeletal problem is arthralgia. Hip arthralgia has been commonly reported in patients undergoing HD. Hip pain can lead to a decrease in levels of physical activity, limitation in joint range of motion, and consequently difficulties in performing activities of daily living (ADL) and impair the quality of life (QoL). The aim of the study is to reveal the prevalence of hip pain and related factors in HD patients. This cross-sectional study included 73 patients on prevalent HD whose ages ranged from 25 to 65 years and who were on HD for more than 6 months. Physical examination and radiological imaging were done to every patient. Visual analog scale, Barthel Index, and Short Form-36 were used to evaluate pain, ADL, and QoL, respectively.

Results

Hip arthralgia was detected in 32 patients. Around 43% of which were diagnosed hip osteoarthritis, 34% greater trochanteric pain syndrome, 15% femoroacetabular impingement, and 6% soft tissue calcifications. Diabetes mellitus and hemodialysis duration were found to be significantly different between the groups of hip pain and without hip pain. Diabetes mellitus was identified as an independent risk factor for hip pain in hemodialysis patients. ADL and QoL were significantly lower in patients with hip pain compared to those without (p < 0.01; p < 0.05, respectively).

Conclusions

The results of our research show that HD patients should be screened for the presence of hip pain and other musculoskeletal disorders and that this is an area which requires further consideration and medical research.

Hypoperfusion of the infrapatellar fat pad and its relationship to MRI T2* relaxation time changes in a 5/6 nephrectomy model

The purpose of present study was to longitudinally investigate the alterations in infrapatellar fat pad (IPFP) vascularity in 5/6 nephrectomized rats by using dynamic contrast enhanced (DCE) MRI and IPFP degeneration by using MRI T2* relaxation time. Twelve male Sprague–Dawley rats were assigned to a control group and a 5/6 nephrectomy CKD group. The right knees of all rats were longitudinally scanned by 4.7 T MRI, and serial changes in the IPFP were assessed at 0, 8, 16, 30, and 44 weeks by DCE-MRI (parameters A, k_el and k_ep) and MRI T2* mapping. After MRI measurements, knee specimens were obtained and evaluated histologically. The CKD group had IPFPs with lower blood volume A and lower permeability k_ep values from 16 weeks (p < 0.05), lower venous washout k_el value from 30 weeks (p < 0.001), and significantly higher T2* values reflecting adipocyte degeneration beginning at 16 weeks (p < 0.05). The histopathological results confirmed the MRI findings. Hypoperfusion and adipocytes degeneration related to CKD were demonstrated in a rodent 5/6 nephrectomy model. DCE parameters and MRI T2* can serve as imaging biomarkers of fat pad degeneration during CKD progression.

The prevalence of pain among patients with chronic kidney disease using systematic review and meta-analysis

Pain is a common but often undertreated symptom in patients with chronic kidney disease (CKD) with a much higher prevalence than in the general population. The aim of this systematic review was to synthesize all available quantitative evidence, in order to gain a better understanding of pain prevalence and pain types in patients with CKD. Four databases and the grey literature were searched until 15th January 2021. Random-effect meta-analyses were conducted with multiple subgroup analyses and meta-regressions to further explore the between-study heterogeneity. The quality of studies included was assessed using the Newcastle-Ottawa scale and the level of evidence was determined using the GRADE approach. One hundred sixteen studies reported data on 40,678 individuals. Results from meta-analyses yielded an overall prevalence of 60% (95% confidence interval 56-64) for pain, 48% (42-55) for chronic pain and 10% (6-15) for neuropathic pain. The prevalence of pain was lower among kidney transplant recipients 46% (37-56) compared with patients undergoing dialysis 63% (57-68) and those with non-dialysis CKD 63% (55-70). Musculoskeletal pain appeared to be the most common pain symptom among patients with CKD managed conservatively 42% (28-56) or receiving dialysis 45% (36-55) whilst abdominal pain was most prevalent in kidney transplant recipients 41% (7-86). Thus, all subgroups of patients with CKD suffer from a high burden of pain. Hence, greater awareness and recognition of this issue is vital to inform policy and service provision in this area.

The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background:

Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD.

Objectives:

To determine the prevalence and severity of chronic pain in patients with CKD.

Design:

Systematic review and meta-analysis.

Setting:

Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity.

Patients:

Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis.

Measurements:

Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain.

Methods:

Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I² statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported.

Results:

Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates.

Limitations:

Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain.

Conclusions:

Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided.

Trial registration:

PROSPERO Registration number CRD42020166965