Depressive symptoms but not chronic pain have an impact on the survival of patients undergoing maintenance hemodialysis

Exploring Chronic Pain in Hemodialysis Patients: An Observational Study Based on the New IASP Classification for ICD-11

INTRODUCTION

Pain is one of the most frequently reported symptoms in hemodialyzed (HD) patients, with prevalence rates between 33% and 82%. Risk factors for chronic pain in HD patients are older age, long-lasting dialysis history, several concomitant diseases, malnutrition, and others. However, chronic pain assessment in HD patients is rarely performed by specialists in pain medicine, with relevant consequences in terms of diagnostic and treatment accuracy. Furthermore, no study has used the recently introduced International Association for the Study of Pain (IASP) pathophysiological classification.

METHODS

In this observational, cross-sectional study in a tertiary HD center in Northern Italy, we analyzed data regarding HD patients, evaluated for 5 months in 2021 by specialists in pain medicine and aimed to identify and characterize chronic pain according to the IASP definition and the last 2019 classification of chronic pain for ICD-11. Pain severity was evaluated by the pain severity score of the brief pain inventory tool.

RESULTS

Among 213 patients, 65 (31%) suffered from chronic pain. The average age was 73.1 years; 55.5% of the patients were male; 53.7% had diabetes, and 39.2% had arterial hypertension. Of the 54 patients subjected to an in-depth evaluation, data regarding 113 pain diagnoses were extracted, particularly related to osteoarthritis, obliterating arterial disease, and low back pain with or without radiculopathy. On the basis of these diagnoses, the pain classification according to the IASP pathophysiological definition highlighted a predominant nociceptive pain type (53.9% of all the diagnoses), followed by neuropathic (22.1%), mixed (22.1%), nociplastic (2.6%), and idiopathic (2.6%) pain. According to the IASP classification for ICD-11, the clinical diagnosis of chronic pain secondary to obliterating arterial disease and diabetes-related foot ulcers could not be assigned to any diagnostic category as a result of the lack of a specific item in the aforementioned classification.

CONCLUSION

This study confirmed that chronic pain is a common, burdening issue in hemodialysis patients and that it is of a prevalent nociceptive nature. Our study highlights some limitations of the last IASP ICD-11 classification, especially the lack of specific items for some pain features that are very frequent in hemodialysis patients, and not only in that population. Finally, this study underlines the importance of mutual collaboration between pain physicians and nephrologists for the well-being of patients of high clinical complexity, such as those undergoing chronic hemodialysis.

Development and Validation of a Nomogram Model for Accurately Predicting Depression in Maintenance Hemodialysis Patients: A Multicenter Cross-Sectional Study in China

Purpose

Depression is a major concern in maintenance hemodialysis. However, given the elusive nature of its risk factors and the redundant nature of existing assessment forms for judging depression, further research is necessary. Therefore, this study was devoted to exploring the risk factors for depression in maintenance hemodialysis patients and to developing and validating a predictive model for assessing depression in maintenance hemodialysis patients.

Patients and Methods

This cross-sectional study was conducted from May 2022 to December 2022, and we recruited maintenance hemodialysis patients from a multicentre hemodialysis centre. Risk factors were identified by Lasso regression analysis and a Nomogram model was developed to predict depressed patients on maintenance hemodialysis. The predictive accuracy of the model was assessed by ROC curves, area under the ROC (AUC), consistency index (C-index), and calibration curves, and its applicability in clinical practice was evaluated using decision curves (DCA).

Results

A total of 175 maintenance hemodialysis patients were included in this study, and cases were randomised into a training set of 148 and a validation set of 27 (split ratio 8.5:1.5), with a depression prevalence of 29.1%. Based on age, employment, albumin, and blood uric acid, a predictive map of depression was created, and in the training set, the nomogram had an AUC of 0.7918, a sensitivity of 61.9%, and a specificity of 89.2%. In the validation set, the nomogram had an AUC of 0.810, a sensitivity of 100%, and a specificity of 61.1%. The bootstrap-based internal validation showed a c-index of 0.792, while the calibration curve showed a strong correlation between actual and predicted depression risk. Decision curve analysis (DCA) results indicated that the predictive model was clinically useful.

Conclusion

The nomogram constructed in this study can be used to identify depression conditions in vulnerable groups quickly, practically and reliably.

Pain Assessment in Patients during Hemodialysis Treatment: Quality Improvement Project

Pain is a prevalent symptom in patients with chronic kidney disease, related to disease progression, comorbidities, and required immobility during dialysis treatment. Nurses must perform detailed pain assessments to manage pain effectively during hemodialysis treatment. This quality improvement project, reported using SQUIRE 2.0, aims to describe pain characteristics in chronic kidney disease patients in a hemodialysis unit clinic in Portugal, implement strategies to improve the pain assessment process in patients with chronic kidney disease during hemodialysis treatment, and assess nurses' satisfaction with the implemented strategies. The study was conducted in a Portuguese hemodialysis clinic, with patients and nurses, in three phases: diagnostic study, protocol implementation, and a descriptive study to assess nurse satisfaction. Seventy-five patients (mean age 71 ± 12.6 years) participated, with 64% reporting moderate chronic pain daily and 48% during hemodialysis treatment. Thirteen nurses considered the pain assessment protocol important, rating their satisfaction at 7.92 ± 1.32 (0-10). Standardizing practices through protocol implementation is likely to improve care and increase nurse satisfaction.

Quality of life and functional capacity in depressive patients on hemodialysis: a systematic review and meta-analysis

Depression is a common disorder in patients with chronic kidney disease (CKD), and some data support its relationship with functional capacity and quality of life. However, to date, this has not been evaluated systematically or through meta-analysis. We sought to investigate the relationship of quality of life and functional capacity with depressive disorder in patients with CKD on hemodialysis. This systematic review considered studies published up to 2021 and included cross-sectional and cohort studies. PubMed, Embase, SPORTDiscus, Web of Science, and Cochrane (CENTRAL) databases were used to search for studies. The New Castle-Ottawa Quality Assessment scale was used to measure the quality of the studies. A total of 4,626 studies were found and, after applying the selection criteria, 16 studies (2,175 patients) remained for qualitative analysis and 10 for meta-analysis (1,484 patients). The physical component summary (MD=-6.563; 95%CI: -9.702 to -3.424) and mental component summary (MD=-18.760; 95%CI: -28.641 to -8.879) were lower in depressive patients, as in all Short Form Health Survey 36 (SF-36) domains. Only one study provided data regarding functional capacity, but it was not evaluated by the defined outcome measure. Twelve studies were classified as "moderate quality" (5 to 6 stars) and four were classified as "low-quality" (0 to 4 stars). This meta-analysis with CKD patients on hemodialysis showed a negative relationship between depression and quality of life, with worsening in all physical and mental domains of the SF-36 in depressed patients.

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.

A systematic review and meta-analysis of the evidence on inflammation in depressive illness and symptoms in chronic and end-stage kidney disease

BACKGROUND

Depression affects approximately 27% of adults with chronic kidney disease (CKD) and end-stage kidney failure (ESKF). Depression in this population is associated with impaired quality of life and increased mortality. The extent of inflammation and the impact on depression in CKD/ESKF is yet to be established. Through a systematic literature review and meta-analysis, we aim to understand the relationship between depression and inflammation in CKD/ESKF patients.

METHODS

We searched nine electronic databases for published studies until January 2022. Titles and abstracts were screened against inclusion and exclusion criteria. Data extraction and study quality assessment was carried out independently by two reviewers. A meta-analysis was carried out where appropriate; otherwise a narrative review of studies was completed.

RESULTS

Sixty studies met our inclusion criteria and entered the review (9481 patients included in meta-analysis). Meta-analysis of cross-sectional associations revealed significantly higher levels of pro-inflammatory biomarkers; C-reactive protein; Interleukin 6 (IL-6) and tumour necrosis factor-alpha in patients with depressive symptoms (DS) compared to patients without DS. Significantly lower levels of anti-inflammatory cytokine IL-10 were found in patients with DS compared to patients without DS. Considerable heterogeneity was detected in the analysis for most inflammatory markers.

CONCLUSION

We found evidence for an association of higher levels of pro-inflammatory and lower anti-inflammatory cytokines and DS in patients with CKD/ESKF. Clinical trials are needed to investigate whether anti-inflammatory therapies will be effective in the prevention and treatment of DS in these patients with multiple comorbidities.

Predictors of disability in patients with chronic low back pain

INTRODUCTION

Chronic low back pain (CLBP) is a common and disabling health problem. In this study, we aimed to assess the relationship between pain intensity, the components of catastrophizing, depression and disability in patients with chronic low back pain.

MATERIAL AND METHODS

Seventy-six patients diagnosed with CLBP (age range 25-77 years; 73.7% female) participated in the study. Participants' socio-demographic data were collected: age, gender, height, weight, and work status (employed or retired). All participants were asked to complete the Pain Catastrophizing Scale (PCS), the visual analogue scale (VAS), the Oswestry Disability Questionnaire (ODQ), and the Beck Depression Inventory (BDI).

RESULTS

The mean group scores revealed moderate CLBP complaints (VAS - 4 [3-6]), mild depression (BDI - 10 [5-16]), a moderate level of catastrophizing (PCS total score 20.5 [10-34]) and moderate disability (Oswestry Disability Index [ODI] - 31 [14-38]). Positive significant correlations were found between ODI and age, residence, work status, VAS, PCS-rumination, PCS-magnification, PCS-helplessness and BDI, and also between PCS subscales and VAS. Our multivariate linear regression analysis showed that age, pain intensity, PCS-helplessness and depression can predict disability in patients with CLBP, explaining 84% of the variance of disability (R² = 0.851, adjusted R² = 0.843).

CONCLUSIONS

A multidisciplinary approach is needed for patients with CLBP and should include physical, mental and social evaluation in order to offer an optimal treatment.

A cross-sectional study on assessing depression among hemodialysis patients

Depression is the most common disorder of psychiatric illness experienced by hemodialysis patients. Failure to measure depression may diminish their well-being. The main objective of this study is to assess depression in hemodialysis patients. The primary goal is to find out the prevalence of depression among chronic kidney disease (CKD) patients. The secondary goal is to find the association between age, sex, and the severity of depression among patients with CKD. This cross-sectional study was performed at the Nephrology Department of King Fahad Hospital, Tabuk, from December 2021 to April 2022. Depression was assessed using a validated Arabic version of the Zung Self-Rating Depression Scale, which is a self-administered questionnaire to assess depression. The mean age of subjects was 42.13 years (standard deviation = 15.65), most of them were in the age group of 18-29 and 40-49 years (n = 59, 24.58%), and the majority were male (n = 128, 53.33%). The depression prevalence among hemodialysis patients was 74.58%. Majority of the patients were with mild depression (n = 175, 72.92%). No significant difference was found for depression among different age groups or genders with ongoing hemodialysis, in our study. Even though the prevalence of depression was high, mostly they were in the mild category. Depression should be assessed frequently, and psychological counseling should be given to improve the well-being of patients.

Self-care self-efficacy and depression associated with quality of life among patients undergoing hemodialysis in Vietnam

Background

Hemodialysis impacts the quality of life of patients with end-stage renal disease. Particularly, depression is the most common psychological condition among patients. Self-care self-efficacy might play an important role in quality of life of patients with hemodialysis.

Objective

This study was designed to explore the relationships among self-care self-efficacy, depression, and quality of life. The second aim was to explore the extent to which self-care self-efficacy and depression explain the variance in quality of life of patients on hemodialysis.

Methods

This cross-sectional study included 127 patients receiving hemodialysis and used the Short Form 36 Health Survey, the Strategies Used by People to Promote Health, and the Patient Health Questionnaire 9 to evaluate quality of life, self-care self-efficacy, and depression. Data was analyzed using independent t-test, analysis of variance, Pearson’s correlation and hierarchical multiple regression.

Results

The findings indicated that self-care self-efficacy was significantly positively correlated (PCS r = .533, p < 0.001, MCS r = .47, p < .001) and depression was significantly negatively correlated (PCS r = −.446, p < .001, MCS r = −.605, p < .001) with the two quality of life components. Self-care self-efficacy and depression were significant predictors of the physical (R²inc = 0.09, β = -0.38, p<0.001, R²inc = 0.12, β = -0.22, p<0.001) and mental (R²inc = 0.04%, β = -0.25, p<0.001, R²inc = 0.33, β = -0.51, p<0.001) quality of life of hemodialysis patients.

Conclusions

Health professionals may target improving self-care self-efficacy and reducing depressive symptoms to enhance patient quality of life.

Assessment of Depression and Anxiety in Patients with Chronic Kidney Disease and after Kidney Transplantation-A Comparative Analysis

Depression and anxiety are common among chronic kidney disease (CKD) patients but are rarely diagnosed and treated. Furthermore, the fraction of patients with depression is greater among hemodialyzed patients. The aim of the study was to assess the prevalence of depression symptoms, anxiety and assess the level of life satisfaction in three groups of patients based on the stage of CKD. The study group consisted of 283 patients—130 females and 153 males, mean aged was 54.7 (±15.3) with stage III–V chronic kidney disease and after kidney transplantation. The Beck Depression Inventory (BDI), the Satisfaction with Life Scale (SWLS), and the State-Trait Anxiety Inventory (STAI) were used. The highest percentage of patients with depressive symptoms was recorded in the group of dialysis patients with stage V CKD. The lowest percentage of patients with high satisfaction with life was noted in the pre-dialysis group. There was a significant relationship between BDI and STAI, SWLS in all groups while a significant relationship between BDI and handgrip strength was observed in dialysis and kidney transplantation patients. Anxiety as a trait was found to be the factor most significantly associated with depressive symptoms in each of the three patient groups. Screen testing and monitoring of the emotional state of patients with CKD are needed, regardless of the stage of the disease and treatment, including patients after kidney transplantation.

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

The Turkish version of the Neck Bournemouth Questionnaire in patients with chronic neck pain: a cultural adaptation, reliability, and validity study

INTRODUCTION

The cultural adaptation of a self-report measurement in different languages is important for developing common strategies for evaluation and treatment. The Neck Bournemouth Questionnaire (NBQ), which was developed to evaluate patients with neck pain, was adapted from the Bournemouth Questionnaire in accordance with the International Classification of Functioning, Disability and Health (ICF) categories. The aim of this study was to conduct the Turkish cultural adaptation, validity and reliability study of the NBQ.

MATERIAL AND METHODS

The study included 119 patients (93 females, 26 males; mean age: 37.2 ±11.8 years) with chronic nonspecific neck pain. The NBQ, Neck Disability Index (NDI) and Nottingham Health Profile (NHP) questionnaires were administered to all the subjects. Test-retest reliability (intraclass correlation coefficient) and the internal consistency (Cronbach's α) were the methods used for the reliability study. The relationship between NBQ, NDI and NHP was investigated for concurrent validity. Exploratory and confirmatory factor analysis was used for construct validity.

RESULTS

The Neck Bournemouth Questionnaire showed good internal consistency (α = 0.87). The test-retest reliability coefficient was 0.913 (95% CI: 0.875-0.940). The correlations between NBQ and NDI and NHP were significant (p < 0.05). The questionnaire was found to have one factor and the explained variance was 59.084% as a result of factor analysis.

CONCLUSIONS

The Neck Bournemouth Questionnaire is a valid and reliable scale for patients with chronic neck pain in the Turkish population.

Late to early velocity index as a predictor of iatrogenic femoral artery pseudoaneurysm recurrence in patients treated with ultrasound-guided thrombin injection

INTRODUCTION

Ultrasound-guided thrombin injection (UGTI) is the preferred treatment of pseudoaneurysms (psA). The potential risk of complications increases with the number of UGTI treatments needed for complete psA obliteration. Identification of risk factors for recurrent psA is needed.

MATERIAL AND METHODS

In total, 508 patients with femoral artery psA underwent UGTI, followed by ultrasound examination repeated twice, at 1-week intervals, to assess UGTI effectiveness. In cases of psA recurrence, the procedure was repeated. Clinical and ultrasound data were prospectively collected.

RESULTS

The psA recurrence occurred in 76 (15%) patients. UGTI was repeated twice in 49 (64%), three times in 15 (20%) and more than three times in 12 (16%) patients. The median thrombin dose was 150 IU (80-250 IU), and was lower in initial procedures than repeated UGTI (p = 0.025). The median psA volume was 2.26 ml (0.86-5.47 ml). The median length of the communicating channel was 4 mm (0-12 mm). A time interval between vessel catheterization and UGTI greater than 7 days (p < 0.001), a late to early velocity index (LEVI) of < 0.2 identified during the outflow phase (p < 0.001), a psA volume > 5 ml (p = 0.032), and a short communicating channel between the psA and the artery (p = 0.037) predicted psA recurrence. Antiplatelet and anticoagulant agents did not increase the risk.

CONCLUSIONS

The LEVI and time interval between artery cannulation and UGTI treatment are strong parameters identifying patients at risk of psA recurrence. The psA volume and communicating channel length are less substantial risks, but still significant. Concomitant antiplatelet and anticoagulant therapy do not affect the success rate of UGTI.

Correlation of sociodemographic profiles with psychological problems among hospitalized patients receiving unplanned hemodialysis

Purpose

In this prospective study, we aimed to examine the sociodemographic factors and clinical factors associated with psychological disorders in chronic kidney disease (CKD) patients receiving unplanned hemodialysis (HD).

Methods

We prospectively enrolled 187 CKD stage 5 patients receiving unplanned HD at a tertiary hospital from January 2015 to December 2016. We used structured questionnaires to gather data about participants’ anxiety, depression, and sleep disturbance. Generalized linear regression analysis was used to examine the relationships between sociodemographic and laboratory parameters, and severity of psychological distress.

Results

The mean age of the participants was 60 years, and the number of men and women was 97 and 90, respectively. We did not find a significant association between anxiety, depression, and sleep disturbance scores and gender, age, marital status, religion status, education levels, and employment status and number of comorbidities. Generalized linear regression analysis showed that a multidisciplinary CKD care program in outpatient clinic disclosed a significant negative association with psychological disorders in participants.

Conclusions

CKD patients exhibited psychological distress when receiving unplanned HD, not closely associated with sociodemographic profiles.

Real-world prognostic factors in autotransplanted multiple myeloma patients with severe renal impairment: study of the Polish Myeloma Study Group

Introduction

The prognostic factors in autotransplanted multiple myeloma (MM) patients with concomitant advanced chronic kidney disease (CKD) are poorly understood, limited, and controversial.

Material and methods

We retrospectively analysed 44 patients with MM and CKD (eGFR < 40 ml/min), present both at diagnosis and at autologous stem cell transplantation (ASCT), with no improvement of renal function in-between.

Results

Patients exhibiting deeper paraprotein responses to pre-transplant treatment predicted better response post ASCT (odds ratio (OR) = 11.6, p = 0.028) and longer progression-free survival (PFS) (hazard ratio (HR) = 0.23, p = 0.017). Higher albumin concentration (per increase of 1 g/dl) (HR = 0.41, p = 0.03) and melphalan 140 mg/m2 versus higher melphalan doses (HR = 0.86, p = 0.008) were associated with longer PFS. Performance status (ECOG 0-1 versus ≥ 2) (HR = 0.28, p = 0.0036), higher albumin concentration (HR = 0.43, p < 0.037), and melphalan 140 mg/m2 versus higher melphalan doses (HR = 0.48, p = 0.081) decreased the risk of death. Three of 32 dialysis-dependent patients became dialysis independent (DID), and 5 of 12 in the DID group had eGFR improvement post ASCT. The median PFS was 2.3 years, which was shorter for DID compared to DD patients (0.7 vs. 3.3 years, respectively). The median overall survival (OS) was 3.6 years, there was no difference in median OS between the groups (4.0 vs. 3.5 years, respectively).

Conclusions

Optimal patient selection including good performance status and higher albumin concentration (with every increase of 1 g/dl), chemotherapy-responsive disease pre-ASCT, melphalan dose adjusted to CKD, and intensive post-transplant supportive care are crucial to achieve acceptable results of treatment of MM patients with CKD.

Nonpharmacological Interventions for Depressive Symptoms in End-Stage Renal Disease: A Systematic Review

Depressive symptoms are common in patients with end-stage renal disease, which can affect treatment and prognosis. We aimed to evaluate the effects of nonpharmacological interventions for depressive symptoms in end-stage renal disease. Eligible studies were identified using PubMed, Web of Science, the Cochrane Library, Embase, and PsycNET (up to March 2019). We identified 24 studies including 1,376 patients. We found that psychological intervention (-0.60, 95% confidence interval [CI] = [-0.87, -0.33]), exercise (-1.13, 95% CI = [-1.56, -0.69]), and manual acupressure (-0.26, 95% CI = [-0.50, 0.03]) were associated with a significant effect on depressive symptoms. However, few studies reported adverse events, and conclusions about safety should be drawn cautiously. While the available data show that nonpharmacological interventions are potential strategies to alleviate depressive symptoms of patients with end-stage renal disease, recommendation of the most efficacious interventions for this population will require future randomized controlled trials with large-scale, long-term intervention.

Health Predictors of Pain in Elderly-A Serbian Population-Based Study

OBJECTIVES

The aim of our study was to evaluate the association of health factors with the presence and different degrees of pain in elderly above 65 years of life.

METHODS

The population-based study included 3540 individuals above 65 years of age of life from twofold stratified household sample representative for Serbia, during 2013 (the average age 73.9 ± 6.3 years; average Body Mass Index was 26.7 ± 4.4, females 56.8%, living with partner 55.5%, with primary education 55.3%, with poor wealth index 55.8% and from rural settings 46.2%). As health predictors of pain, we analyzed further health parameters: self-perceived general health, long-lasting health problems, diagnosed pulmonary disease, cardiovascular disease, musculoskeletal disease, diabetes, hyperlipidemia, hypertension and other chronic diseases. Pain domain of SF-36 version 2.0 was used for pain assessment.

RESULTS

Significant health predictors of pain were: self-perceived general health (OR 2.28), where bad perception of self-perceived general health in our study had greater risk of pain with higher degree of severity; long-lasting health problems (OR 1.60), where elderly with long-lasting health problems had almost twice the risk of moderate degree of pain, and above twice the risk for severe degree of pain; pulmonary disease (OR 1.38); musculoskeletal disease (OR 2.98) and other chronic diseases (OR 1.71). The presence of musculoskeletal disease increases the risk for pain, even more than double in severe versus mild degrees of pain.

CONCLUSION

Bad self-perceived general health, long-lasting health problems, pulmonary, musculoskeletal diseases, cardiovascular disease and other chronic disease were significant health-related predictors of various degrees of pain in elderly.

The positive influence of psychological intervention on the level of anxiety and depression in dialysis patients: A pilot study

Medical progress in dialysis therapy made it possible to treat patients with the end-stage renal disease for many years. But at the other side it may lead to profound changes in everyday life and may induce depression and anxiety. The research presented in this article explores the influence of psychological interventions on anxiety and depression levels in patients undergoing dialysis therapy. The experimental design included two experimental groups: cognitive intervention and cognitive/narrative intervention and one control group (standard treatment). In total, 139 participants aged 22–75, including 67 women and 72 men diagnosed with end-stage renal disease and treated with dialysis, were divided into a control group and two experimental groups. Two well-known tools were used in the study: Beck Depression Inventory and State-Trait Anxiety Inventory. It was indicated that cognitive intervention may decrease the level of anxiety as a state, whereas cognitive/narrative intervention may decrease the level of anxiety as a state and the level of depression in dialysis patients. The stronger effect in the case of using narrative therapy may be the consequence of the fact that narrative therapy stimulates deeper analysis of the discussed issues (involving emotional level).

Assessing and Treating Chronic Pain in Patients with End-Stage Renal Disease

Pain is one of the most common symptoms among patients with end-stage renal disease (ESRD), and is often under recognized and not adequately managed in hemodialysis (HD) patients. Barriers to adequate pain management include poor awareness of the problem, insufficient medical education, fears of possible drug-related side effects, and common misconceptions about the inevitability of pain in elderly and HD patients. Caregivers working in HD should be aware of the possible consequences of inadequate pain assessment and management. Common pain syndromes in HD patients include musculoskeletal diseases and metabolic neuropathies, associated with typical intradialytic pain. Evaluating the etiology, nature, and intensity of pain is crucial for choosing the correct analgesic. A mechanism-based approach to pain management may result in a better outcome. Pharmacokinetic considerations on clearance alterations and possible toxicity in patients with ESRD should drive the right analgesic prescription. Comorbidities and polymedications may increase the risk of drug-drug interactions, therefore drug metabolism should be taken into account when selecting analgesic drugs. Automedication is common among HD patients but should be avoided to reduce the risk of hazardous drug administration. Further research is warranted to define the efficacy and safety of analgesic drugs and techniques in the context of patients with ESRD as generalizing information from studies conducted in the general population could be inappropriate and potentially dangerous. A multidisciplinary approach is recommended for the management of complex pain syndromes in frail patients, such as those suffering from ESRD.