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

Effectiveness of rehabilitation in hospitalized hemodialysis patients as compared with rehabilitation in hospitalized patients not on hemodialysis: a retrospective cohort study

BACKGROUND

The effectiveness of rehabilitation aimed at improving the activities of daily living and physical functions may differ between hospitalized patients undergoing hemodialysis (HD) and not undergoing HD (non-HD). The aim of the present study was to compare the outcomes of rehabilitation between hospitalized HD and non-HD patients.

METHODS

This was a retrospective cohort study of inpatients who underwent rehabilitation. We measured the rehabilitation time (min/day), length of hospital stay (days), and the Barthel index (BI). In addition, at the time of admission and discharge, grip strength, isometric knee extension strength, 10 m walking speed, timed up and go test, and short physical performance battery were examined. The outcomes were then compared between the HD and non-HD groups.

RESULTS

This study was made up of 902 patients (non-HD group: 765, HD group: 137). Our analysis revealed a lower rehabilitation time [43.3 (0.6) vs. 38.8 (1.2) min/day] and longer hospital stay [48.5 (0.5) vs. 58.1 (2.3) days] in the HD group as compared with the non-HD group (p < 0.05). In addition, the 10 m walking speed [0.75 (0.02) vs. 0.66 (0.03) m/s], timed up and go test [20.8 (0.7) vs. 24.3 (1.0) sec], and short physical performance battery [6.3 (0.6) vs. 4.7 (0.6) points] at discharge were also significantly lower in the HD group as compared with the non-HD group (p < 0.05).

CONCLUSION

Rehabilitation efforts for HD patients need to be improved by securing more time for inpatient rehabilitation and promoting mobility function improvement for these patients.

Effect of Acupuncture Intervention on Chronic Musculoskeletal Pain in Hemodialysis-Dependent Kidney Failure Patients: Study Protocol for a Randomized Controlled Clinical Trial

Background

Chronic musculoskeletal pain is prevalent in individuals with hemodialysis-dependent renal failure (HDKF). The current opioid crisis highlights the urgent need for effective non-pharmacological pain management. Acupuncture, identified as a non-pharmacological intervention in clinical settings, holds promise for alleviating chronic musculoskeletal pain in HDKF patients, but well-designed studies assessing its specific effects in this population are lacking. This study aims to comprehensively evaluate the efficacy and safety of acupuncture as a treatment modality for HDKF patients with chronic musculoskeletal pain.

Methods

This trial, conducted at a single center, follows a parallel, three-arm design with randomization and sham control. 90 hDKF patients with chronic musculoskeletal pain will be assigned randomly to three groups (acupuncture, sham acupuncture, and waiting-list control) in a 1:1:1 ratio. The acupuncture and sham acupuncture groups will undergo 24 treatment sessions over eight weeks, while the waiting-list control group will receive no acupuncture. The primary outcome measures changes in the Numeric Rating Scale (NRS) score from baseline at the end of treatment, with secondary outcomes including the Edmonton Symptom Assessment System (revised version) (ESAS-r), Palliative care Outcome Scale (rental) (POS-renal), and hospital anxiety and depression scale (HADS). Adverse events will be recorded throughout the study, and all randomized patients will be included in the intention-to-treat analysis.

Discussion

The outcomes of this research aim to advance the systematic management of chronic musculoskeletal pain in HDKF patients through non-pharmacological interventions. Moreover, it will contribute insights into personalized treatment strategies, integrating individual expectations and genetic biomarkers to provide "precision" acupuncture for HDKF patients experiencing chronic musculoskeletal pain.

Trial Registration

The trial registration number is ChiCTR2400080488. This trial was prospectively registered on 30 January 2024 in the Chinese Clinical Trial Registry.

Effects of a combined aerobic and core stabilization exercise training program on functional capacity, pain, and health-related quality of life in hemodialysis and kidney transplant patients

BACKGROUND

Chronic kidney disease (CKD) poses a significant public health challenge globally while impacting patients' physical function and quality of life. Addressing the issues of physical inactivity and pain management is essential during treatment to improve health-related quality of life. The present study investigated the effect of an aerobic training program with core stabilization exercises for hemodialysis (HD) patients on a transplant waiting list and renal transplant (RTx) patients.

METHODS

A total of 45 patients with CKD were included in the 12-week study: 25 patients receiving HD (12 HD treatment group, 13 HD control group) and 20 patients with RTx (9 RTx treatment group, 11 RTx control group). Functional capacity was measured using the 6-min walk test, pain was measured using the visual analog scale, and health-related quality of life was measured using the Kidney Disease Quality of Life-Short Form 12 questionnaire. Nonparametric statistical tests were performed at a significance level of 0.05.

RESULTS

Both the HD and RTx treatment groups showed significantly reduced times for the 6-min walking test (p = 0.002 and p = 0.008, respectively), significantly reduced pain severity (p = 0.002 and p = 0.008, respectively), and significantly improved quality of life scores (p = 0.006 and p = 0.041, respectively) by the end of the study compared with control groups.

CONCLUSION

Based on the results, structured exercise programs could be effective therapies in CKD management. Therefore, health providers should promote their integration into routine care practices to enhance patient outcomes and well-being.

Investigation of core symptoms and symptom clusters in maintenance hemodialysis patients: A network analysis

PURPOSE

To construct a symptom network of maintenance hemodialysis patients and identify the core symptoms and core symptom clusters. Finally, this study provides a reference for accurate symptom management.

DESIGN AND METHOD

A correlational cross-sectional design. A total of 368 patients who underwent maintenance hemodialysis were enrolled from two hemodialysis centers in Chengdu, Sichuan Province, China. A symptom network was constructed with the R coding language to analyze the centrality index. Symptom clusters were extracted by exploratory factor analysis, and core symptom clusters were preliminarily determined according to the centrality index of the symptom network.

FINDINGS

The most common symptoms in maintenance hemodialysis patients were fatigue, dry skin, and pruritus. In the symptom network, headache had the highest mediation centrality (rB = 2.789) and closeness centrality (rC = 2.218) and the greatest intensity of numbness or tingling in the feet (rS = 1.952). A total of six symptom clusters were extracted, including pain and discomfort symptom clusters, emotional symptom clusters, gastrointestinal symptom clusters, sleep disorder symptom clusters, dry symptom clusters, and sexual dysfunction symptom clusters. The cumulative variance contribution rate was 69.269%.

CONCLUSIONS

Fatigue, dry skin, and pruritus are the sentinel symptoms of maintenance hemodialysis patients, headache is the core symptom and bridge symptom, and pain symptom clusters are the core symptom clusters of MHD patients. Nurses can develop interventions based on core symptoms and symptom clusters to improve the effectiveness of symptom management in maintenance hemodialysis patients.

CLINICAL RELEVANCE

Understanding the core symptoms and symptom groups that plague maintenance hemodialysis patients is critical to providing accurate symptom management. To ensure that maintenance hemodialysis patients receive effective support during treatment, reduce the adverse effects of symptoms, and improve the quality of life of patients.

The impact of photobiomodulation on sleep and life quality in hemodialysis patients: A randomized controlled trial

The quality of life (QoL) and sleep quality are closely linked to the physical and psychological health of end-stage renal disease (ESRD) patients, especially those underwent hemodialysis (HD) therapy. This study aims to investigate the impact of 830 nm laser treatment on improving QoL and sleep quality in HD patients. Forty ESRD patients participated in this study. 830 nm laser was used to radiate on the palm (at dose of 256.10 J/cm2), ST 36 and KI 1 acupoints (at dose of 109.76 J/cm2) of HD patients, and QoL and sleep quality questionnaires were utilized to assess changes following the treatment. After 830 nm laser radiation, lower global Pittsburgh Sleep Quality Index and Athens Insomnia Scale scores were observed, accompanied by higher physical and mental component summary scores in MOS 36-item short-form health survey version 2 and a global World Health Organization Quality of Life Brief Version score. The laser group also showed significant improvements in QoL and sleep quality indicators. Additionally, pain levels decreased on the third day and after one month according to visual analogue scale. This study revealed the positive effects of 830 nm laser on palm, KI 1 and ST 36 acupoints for improving the QoL and sleep quality in ESRD patients underwent HD treatment. The results suggest that 830 nm laser applied to specific targets could be used as a complementary and alternative approach to increase the QoL and sleep quality in ESRD patients.

Central sensitization: its prevalence and impact on quality of life among hemodialyzed patients

BACKGROUND/AIM

Data on the role of central sensitization in hemodialyzed patients are scarce. The aim was to identify the impact of central sensitization on quality of life and elucidate the risk factors for the development of central sensitization in patients receiving hemodialysis.

METHODS

Central sensitization, quality of life, psychological well-being, and sleep were assessed by the Central Sensitization Inventory (CSI), abbreviated version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF), Hospital Anxiety and Depression Scale (HADS), and Jenkins Sleep Evaluation Scale (JSS), respectively. The effect of central sensitization on quality of life and the predictors of the development of central sensitization were assessed by regression analyses.

RESULTS

The frequency of central sensitization was 48% in the study population (n = 100). Patients with central sensitization had significantly higher pain intensity, worse sleep quality, and more impaired psychological status (p < 0.05 for all). The CSI score negatively affected all quality of life domains on its own (p < 0.001 for all, adjusted R2 ranged from 0.17 to 0.47). Dialysis vintage (OR, 0.8; 95% CI, 0.7 to 1.0), pain (OR, 1.5; 95% CI, 1.1 to 2.0), JSS (OR, 1.3; 95% CI, 1.1 to 1.5), and HADS-total (OR, 1.1; 95% CI, 1.0 to 1.2) were determined as the independent risk factors for central sensitization (p < 0.05 for all).

CONCLUSION

This study confirms that given the high frequency of central sensitization and its significant negative impact on quality of life, the presence of central sensitization should be investigated in patients undergoing hemodialysis.

Knowledge and Attitudes of Dialysis Patients Toward Kidney Transplantation: Preliminary Report from a Pilot Study Preceding a Cross-Sectional Nationwide Evaluation

BACKGROUND

The knowledge and attitudes of dialyzed patients toward the best method of renal replacement treatment (ie, kidney transplantation [KTx]) may be the main factor motivating them to apply and be put on the national kidney transplant waiting list, resulting in a better prognosis.

OBJECTIVE

Assessment of the knowledge and attitudes of dialyzed patients toward KTx.

METHODS

A pilot study is considered an introductory step before the nationwide project, which will cover dialysis centers in Poland from 2023 to 2024. The authorship 4-part questionnaire, including self-assessment knowledge, attitude dimension, pain and mental evaluation section, was made available to 30 patients with hemodialysis aged 30 to 75 years.

RESULTS

The median age of the patients was 59 years. The primary cause of end-stage renal disease (ESRD) was glomerulonephritis (33%). Most of the patients stayed on hemodialysis for 2 years or less (57%); 43% of the patients declared insufficient knowledge in the field of KTx, 41% of the patients were not informed at the nephrology clinic that KTx remains one of the methods of renal replacement therapy, and 65% did not receive information about the possibility of preemptive or early transplantation from a relative donor. Only 34% of the patients considered KTx to be a much better treatment option than dialysis, but only 20% of those were on the national waiting list for KTx.

CONCLUSIONS

The pilot study showed insufficient knowledge of patients with ESRD regarding kidney transplantation as a method of renal replacement therapy. There is a need to introduce an effective educational program.

The Effectiveness of Benson's Relaxation Technique on Pain and Perceived Stress Among Patients Undergoing Hemodialysis: A Double-Blind, Cluster-Randomized, Active Control Clinical Trial

Benson's relaxation affects many symptoms among hemodialysis patients. A cluster-randomized active control clinical trial with three repeated measures; pre, 1-week, and 1-month post-intervention sought to evaluate the effectiveness of Benson's Relaxation on pain and perceived stress (P&PS) among hemodialysis patients. Two governmental hospitals were randomly assigned to intervention and control. Thirty-six participants were randomly selected; 18 were intervention, and 18 were controlled. The intervention group performed Benson's Relaxation twice a day for 10 minutes for 8 weeks after a training session. The control group received an educational session about Progressive Relaxation. Findings revealed a statistically significant reduction in the PSS-10 and PRI scores between pre-intervention and 1 month after-intervention (p < .001) and at 1 week after intervention and 1 month after-intervention (p < .001). A non-statistically significant reduction between pre-intervention and 1 week after-intervention (p > .05). Benson's Relaxation significantly relieved P&PS among hemodialysis patients but not after only 1 week of practicing.

Transcranial Direct Current Stimulation (tDCS): Pain Management in End-Stage Renal Disease - Report of an Early Randomized Controlled Trial

CONTEXT

Chronic pain in end-stage renal disease (ESRD) is an increasingly neglected clinical problem affecting more than 60% of patients. Long-term chronic pain could be associated with brain imbalance in circuits of pain matrix and is associated with poor quality of life (QoL) and mood disturbance.

OBJECTIVES

The aim of this study was evaluating the effects of transcranial direct current stimulation (tDCS) on pain, QoL, depression, anxiety and affectivity in ESRD patients undergoing hemodialysis (HD).

METHODS

This double-blind, randomized, sham-controlled trial included 30 patients with chronic pain undergoing HD. Participants were allocated to Active tDCS and Sham tDCS and received ten non-consecutive sessions of anodal motor cortex stimulation (M1/Sp2 montage) at 2 mA intensity for 20 min. The primary outcome was pain assessed using numeric rating scale (NRS) and collected at baseline, immediately after the 10th day of intervention, one week, two weeks, and four weeks after the last stimulation. Secondary outcomes included QoL, depression, anxiety and affectivity collected before and after intervention.

RESULTS

A mixed ANOVA model showed significant interaction between group and time on pain F(4.112) = 3.106, P = 0.01 with main effects of group (P = 0.03). Before and after intervention, a significant improvement was observed in QoL (P = 0.009), general health (P = 0.03), fatigue (P = 0.05), symptoms (P = 0.05) depression (P = 0.01) and anxiety (P = 0.01). No difference was found for affectivity.

CONCLUSION

Anodal tDCS over the motor cortex emerges as a potential therapeutic approach for improving pain, QoL, and mood in patients with ESRD.

Impact of Hospitalization on the Quality of Life of Patients with Chronic Kidney Disease in Saudi Arabia

Chronic kidney disease (CKD) is a global health problem. CKD causes patients to be hospitalized for a longer time to treat the disease. The impact of the hospitalization brings major changes and affects the quality of life (QoL) of the patients. In this study, we aimed to evaluate the impact of hospitalization on the QoL of patients with CKD. A cross-sectional study was conducted at the inpatient departments (IPDs) and outpatient departments (OPDs) of selected hospitals, in the eastern region of Saudi Arabia. The kidney disease quality of life (KDQOL) scale was used for the data collection and the findings were analyzed. The hospitalized patients had a poorer QoL than the OPD patients. The physical component summary (PCS) and mental component summary (MCS) mean scores were 52.82 ± 2.32 and 52.57 ± 2.93 in IPD patients, respectively, and 63.46 ± 3.65 and 66.39 ± 0.91 in OPD patients, respectively, which was significant (p < 0.0001). The QoL of patients decreased in the end stages of CKD. A significant association was observed between gender, occupation, smoking, and the stages of CKD with the QoL of the hospitalized patients. Measures must be taken to improve the QoL of these patients at all levels.

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.