Pain is common among patients with stage 3 or higher chronic kidney disease (CKD), those receiving dialysis, and kidney transplant recipients, a new study finds.
In a systematic review and meta-analysis involving 116 studies and 40,678 individuals, 60% had pain, 48% had chronic pain lasting more than 3 months, and 10% had neuropathic pain, Samira Bell, MB ChB, of the University of Dundee in Scotland and colleagues reported in Kidney International.
Overall pain prevalence was lower among kidney transplant recipients (46%) compared with patients undergoing dialysis (63%) and patients with nondialysis CKD (63%). Individuals on hemodialysis and peritoneal dialysis had similar pain prevalence. Among patients with nondialysis CKD, those with stage 3 or 4 diseases reported pain as often as those with stage 5 disease, probably because these patients received palliative care, according to the investigators.
Neuropathic pain affected higher proportions of patients with diabetes, hypertension, or a high body mass index. Diabetes may lead to diabetic neuropathy, hypertension may impair nerve conduction, and obesity may cause systemic inflammation leading to nerve damage, the investigators noted.
Musculoskeletal pain was the most common pain symptom among patients with CKD managed conservatively (42%) or receiving dialysis (45%) but was less prevalent among kidney transplant recipients (18%). According to the researchers, musculoskeletal pain, which includes bone and joint pain, may relate to CKD-Mineral and Bone Disorder (CKD-MBD), such as secondary hyperparathyroidism. Fibromyalgia was significantly associated with older age.
Abdominal pain was most prevalent in kidney transplant recipients (41%), whereas it was a lesser concern for patients with nondialysis CKD (15%) and on dialysis (16%). According to the investigators, abdominal pain in kidney transplant recipients may relate to persistent postsurgical pain; visceral hyperalgesia; the inherent toxicity of immunosuppressant drugs (particularly mycophenolate mofetil and sirolimus) leading to mucosal injury, ulceration, diverticular disease, and in the worst case perforation; or the high number of daily medications.
“The burden of pain is high in patients with CKD, especially among the CKD non-dialysis subgroup and those treated with dialysis, reinforcing the benefit of kidney transplantation on quality of life,” Dr. Bell’s team concluded. “However, the burden of pain among kidney transplant recipients is not insignificant. Comprehensive pain assessments must rely on validated scales. Greater awareness of this common symptom is vital in order to reduce its prevalence and prevent unnecessary suffering in a group of patients whose quality of life is already altered by chronic kidney disease.”
Lambourg E, Colvin L, Guthrie G, et al. The prevalence of pain among patients with chronic kidney disease using systematic review and meta-analysis. Kidney Int. Published online April 30, 2021. doi:10.1016/j.kint.2021.03.041