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Devaraj SM, Roumelioti ME, Yabes JG, Schopp M, Erickson S, Steel JL, Rollman BL, Weisbord SD, Unruh M, Jhamb M. Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study. KIDNEY360 2023; 4:e1265-e1275. [PMID: 37461138 PMCID: PMC10547226 DOI: 10.34067/kid.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/23/2023] [Accepted: 07/10/2023] [Indexed: 09/29/2023]
Abstract
Key Points Lower neighborhood walkability was associated with higher depressive symptoms and fatigue and younger age with depressive symptoms. Depressive symptoms, pain, and fatigue were frequently reported, often occurred together, and were often not all already treated. Patients with a higher symptom burden and men may be more likely to be ready to seek treatment for depressive symptoms, pain, or fatigue. Background Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial. Methods In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0–10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9), and readiness to seek treatment (5–item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi square, Fisher exact tests, and logistic regression models. Results From March 2018 to December 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% female, 17% Black, 25% American Indian, and 25% Hispanics). Of them, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age younger than 65 years was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (P <0.05). The percentage of patients ready to seek treatment increased with symptom burden. More men reported readiness to seek treatment (85% versus 68% of women, P <0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60,000/yr: odds ratio [OR]=0.16, confidence interval [CI]=0.03 to 0.76) and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19 to 24.05) and fatigue (OR= 5.29, CI=1.38 to 20.33). Conclusions Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.
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Affiliation(s)
- Susan M. Devaraj
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Jonathan G. Yabes
- Center for Research on Heath Care Data Center, Division of General Internal Medicine; Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Schopp
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L. Steel
- Department of Surgery, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce L. Rollman
- Center for Behavioral Health, Media, and Technology, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven D. Weisbord
- Renal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Lockwood MB, Steel JL, Doorenbos AZ, Contreras BN, Fischer MJ. Emerging Patient-Centered Concepts in Pain Among Adults With Chronic Kidney Disease, Maintenance Dialysis, and Kidney Transplant. Semin Nephrol 2021; 41:550-562. [PMID: 34973699 PMCID: PMC8740641 DOI: 10.1016/j.semnephrol.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience an increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacologic treatments for pain that targets coping as well as comorbid anxiety and depression has been increasing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence-based, nonpharmacologic treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about the effects of these treatments among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, which may be useful to future kidney disease research and treatment.
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Affiliation(s)
- Mark B Lockwood
- Department of Behavioral Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL.
| | - Jennifer L Steel
- Center for Excellence in Behavioral Medicine, Department of Surgery, University of Pittsburg, Pittsburg, PA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL
| | - Blanca N Contreras
- Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Michael J Fischer
- Department of Internal Medicine, University of Illinois Hospital and Health Sciences Center, Chicago, IL; Renal Section, Medical Service, Jesse Brown VA Medical Center, Chicago, IL; Center of Innovation for Complex Chronic Health Care, Edward Hines, Jr. VA Hospital, Hines, IL
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Brintz CE, Cheatle MD, Dember LM, Heapy AA, Jhamb M, Shallcross AJ, Steel JL, Kimmel PL, Cukor D. Nonpharmacologic Treatments for Opioid Reduction in Patients With Advanced Chronic Kidney Disease. Semin Nephrol 2021; 41:68-81. [PMID: 33896475 DOI: 10.1016/j.semnephrol.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Opioid analgesics carry risk for serious health-related harms in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease. In the general population with chronic noncancer pain, there is some evidence that opioid reduction or discontinuation is associated with improved pain outcomes; however, tapering opioids abruptly or without providing supportive interventions can lead to physical and psychological harms and relapse of opioid use. There is emerging evidence that nonpharmacologic treatments such as psychosocial interventions, acupuncture, and interdisciplinary pain management programs are effective approaches to support opioid dose reduction in patients experiencing persistent pain, but research in this area still is relatively new. This review describes the current evidence for nonpharmacologic interventions to support opioid reduction in non-CKD patients with pain and discusses the application of the available evidence to patients with advanced CKD who are prescribed opioids to manage pain.
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Affiliation(s)
- Carrie E Brintz
- Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
| | - Martin D Cheatle
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Laura M Dember
- Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alicia A Heapy
- Pain Research Informatics Multimorbidities and Education Center of Innovation, Veterans' Affairs Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Amanda J Shallcross
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Jennifer L Steel
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA; Behavioral Health, The Rogosin Institute, New York, NY
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Daniel Cukor
- Behavioral Health, The Rogosin Institute, New York, NY
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C Evans M, Bazargan M, Cobb S, Assari S. Pain Intensity among Community-Dwelling African American Older Adults in an Economically Disadvantaged Area of Los Angeles: Social, Behavioral, and Health Determinants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3894. [PMID: 31615105 PMCID: PMC6843192 DOI: 10.3390/ijerph16203894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although social, behavioral, and health factors influence prevalence and intensity of pain, very few studies have investigated correlates of pain among economically disadvantaged older African American (AA) adults. OBJECTIVE This study explored social, behavioral, and health correlates of pain intensity among community-dwelling AA older adults in an economically disadvantaged area of Los Angeles. METHODS A cross-sectional study on 740 AA older adults (age ≥ 55 years) was conducted in South Los Angeles between 2015 and 2018. Exploratory variables were age, gender, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, pain-related chronic medical conditions (CMCs), and depressive symptoms. Dependent variable was pain intensity. Linear regression was used for data analysis. RESULTS Age, financial difficulties, living alone, smoking, pain-related chronic medical conditions, and depressive symptoms were associated with pain intensity. Individuals with lower age, higher financial difficulties, those who lived alone, those with a higher number of pain-related chronic medical conditions, more depressive symptoms, and nonsmokers reported more pain intensity. Gender, educational attainment, marital status, and drinking were not associated with pain intensity. CONCLUSION The results may help with the health promotion of economically disadvantaged AA older adults in urban areas.
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Affiliation(s)
- Meghan C Evans
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
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Kimmel PL, Fwu CW, Abbott KC, Eggers AW, Kline PP, Eggers PW. Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients. J Am Soc Nephrol 2017; 28:3658-3670. [PMID: 28935654 DOI: 10.1681/asn.2017010098] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/08/2017] [Indexed: 11/03/2022] Open
Abstract
Aggressive pain treatment was advocated for ESRD patients, but new Centers for Disease Control and Prevention guidelines recommend cautious opioid prescription. Little is known regarding outcomes associated with ESRD opioid prescription. We assessed opioid prescriptions and associations between opioid prescription and dose and patient outcomes using 2006-2010 US Renal Data System information in patients on maintenance dialysis with Medicare Part A, B, and D coverage in each study year (n=671,281, of whom 271,285 were unique patients). Opioid prescription was confirmed from Part D prescription claims. In the 2010 prevalent cohort (n=153,758), we examined associations of opioid prescription with subsequent all-cause death, dialysis discontinuation, and hospitalization controlled for demographics, comorbidity, modality, and residence. Overall, >60% of dialysis patients had at least one opioid prescription every year. Approximately 20% of patients had a chronic (≥90-day supply) opioid prescription each year, in 2010 usually for hydrocodone, oxycodone, or tramadol. In the 2010 cohort, compared with patients without an opioid prescription, patients with short-term (1-89 days) and chronic opioid prescriptions had increased mortality, dialysis discontinuation, and hospitalization. All opioid drugs associated with mortality; most associated with worsened morbidity. Higher opioid doses correlated with death in a monotonically increasing fashion. We conclude that opioid drug prescription is associated with increased risk of death, dialysis discontinuation, and hospitalization in dialysis patients. Causal relationships cannot be inferred, and opioid prescription may be an illness marker. Efforts to treat pain effectively in patients on dialysis yet decrease opioid prescriptions and dose deserve consideration.
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Affiliation(s)
- Paul L Kimmel
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;
| | - Chyng-Wen Fwu
- Social and Scientific Systems, Inc., Silver Spring, Maryland
| | - Kevin C Abbott
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Prudence P Kline
- Department of Medicine, George Washington University, Washington, DC
| | - Paul W Eggers
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Brkovic T, Burilovic E, Puljak L. Risk Factors Associated with Pain on Chronic Intermittent Hemodialysis: A Systematic Review. Pain Pract 2017; 18:247-268. [DOI: 10.1111/papr.12594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/28/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Tonci Brkovic
- Divison of Nephrology and Hemodialysis; Department of Internal Medicine; University Hospital Split; Split Croatia
| | - Eliana Burilovic
- Department of Psychiatry; University Hospital Split; Split Croatia
| | - Livia Puljak
- Laboratory for Pain Research; University of Split School of Medicine; Split Croatia
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Weisbord SD. Patient-Centered Dialysis Care: Depression, Pain, and Quality of Life. Semin Dial 2016; 29:158-64. [DOI: 10.1111/sdi.12464] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Steven D. Weisbord
- Renal Section; Medicine Service Line and the Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System; Pittsburgh Pennsylvania
- Renal-Electrolyte Division; Department of Medicine; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
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9
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Brkovic T, Burilovic E, Puljak L. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review. Patient Prefer Adherence 2016; 10:1131-50. [PMID: 27382261 PMCID: PMC4922783 DOI: 10.2147/ppa.s103927] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Understanding the epidemiology of pain in patients on hemodialysis (HD) is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. MATERIALS AND METHODS We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool. RESULTS We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain. CONCLUSION The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients' quality of life and pain-related disability.
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Affiliation(s)
- Tonci Brkovic
- Department of Internal Medicine, Division of Nephrology
| | | | - Livia Puljak
- Department of Anatomy, Histology and Embryology, Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
- Correspondence: Livia Puljak, Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia, Tel +385 21 557 807, Fax +385 21 557 811, Email
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Weisbord SD, Mor MK, Sevick MA, Shields AM, Rollman BL, Palevsky PM, Arnold RM, Green JA, Fine MJ. Associations of depressive symptoms and pain with dialysis adherence, health resource utilization, and mortality in patients receiving chronic hemodialysis. Clin J Am Soc Nephrol 2014; 9:1594-602. [PMID: 25081360 DOI: 10.2215/cjn.00220114] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Depressive symptoms and pain are common in patients receiving chronic hemodialysis, yet their effect on dialysis adherence, health resource utilization, and mortality is not fully understood. This study sought to characterize the longitudinal associations of these symptoms with dialysis adherence, emergency department (ED) visits, hospitalizations, and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS As part of a trial comparing symptom management strategies in patients receiving chronic hemodialysis, this study prospectively assessed depressive symptoms using the Patient Health Questionnaire 9, and pain using the Short-Form McGill Pain Questionnaire, monthly between 2009 and 2011. This study used negative binomial, Poisson, and proportional hazards regression to analyze the longitudinal associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with missed and abbreviated hemodialysis treatments, ED visits, hospitalizations, and mortality, respectively. RESULTS Among 286 patients, moderate-to-severe depressive symptoms were identified on 788 of 4452 (18%) assessments and pain was reported on 3537 of 4459 (79%) assessments. Depressive symptoms were independently associated with missed (incident rate ratio [IRR], 1.21; 95% confidence interval [95% CI], 1.10 to 1.33) and abbreviated (IRR, 1.08; 95% CI, 1.03 to 1.14) hemodialysis treatments, ED visits (IRR, 1.24; 95% CI, 1.12 to 1.37), hospitalizations (IRR, 1.19; 95% CI, 1.10 to 1.30), and mortality (IRR, 1.40; 95% CI, 1.11 to 1.77). Pain was independently associated with abbreviated hemodialysis treatments (IRR, 1.03; 95% CI, 1.01 to 1.06) and hospitalizations (IRR, 1.05; 95% CI, 1.00 to 1.10). Severe pain was independently associated with abbreviated hemodialysis treatments (IRR, 1.16; 95% CI, 1.06 to 1.28), ED visits (IRR, 1.58; 95% CI, 1.28 to 1.94), and hospitalizations (IRR, 1.22; 95% CI, 1.03 to 1.45), but not mortality (hazard ratio, 1.71; 95% CI, 0.81 to 2.96). CONCLUSIONS Depressive symptoms and pain are independently associated with dialysis nonadherence and health services utilization. Depressive symptoms are also associated with mortality. Interventions to alleviate these symptoms have the potential to reduce costs and improve patient-centered outcomes.
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Affiliation(s)
- Steven D Weisbord
- Renal Section, Medicine Service Line, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Renal-Electrolyte Division, Department of Medicine, and
| | - Maria K Mor
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Ann Sevick
- Department of Population Health, New York University School of Medicine, New York, New York; and
| | - Anne Marie Shields
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Bruce L Rollman
- Department of Population Health, New York University School of Medicine, New York, New York; and
| | - Paul M Palevsky
- Renal Section, Medicine Service Line, and Renal-Electrolyte Division, Department of Medicine, and
| | - Robert M Arnold
- Divisions of General Internal Medicine and Palliative Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jamie A Green
- Nephrology Department, Geisinger Medical Center, Danville, Pennsylvania
| | - Michael J Fine
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Divisions of General Internal Medicine and
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Upadhyay C, Cameron K, Murphy L, Battistella M. Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools. Clin Kidney J 2014; 7:367-72. [PMID: 25852910 PMCID: PMC4377812 DOI: 10.1093/ckj/sfu067] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/10/2014] [Indexed: 01/11/2023] Open
Abstract
Background Patients undergoing hemodialysis frequently report pain with multifactorial causes, not limited to that experienced directly from hemodialysis treatment. Their pain may be nociceptive, neuropathic, somatic or visceral in nature. Despite this, pain in this population remains under-recognized and under-treated. Although several tools have been used to measure pain in patients undergoing hemodialysis as reported in the literature, none of them have been validated specifically in this population. The objective for this review was to compare and contrast these pain assessment tools and discuss their clinical utility in this patient population. Methods To identify pain assessment tools studied in patients undergoing hemodialysis, a literature search was performed in PubMed and Medline. An expert panel of dialysis and pain clinicians reviewed each tool. Each pain assessment tool was assessed on how it is administered and scored, its psychometric properties such as reliability, validity and responsiveness to change, and its clinical utility in a hemodialysis population. Brief Pain Inventory, McGill Pain Questionnaire, Pain Management Index, Edmonton Symptom Assessment System, Visual Analogue Scale and Faces Pain Scale were evaluated and compared. Results This assessment will help clinicians practicing in nephrology to determine which of these pain assessment tools is best suited for use in their individual clinical practice.
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Affiliation(s)
| | - Karen Cameron
- Pharmacy , University Health Network, University of Toronto , Toronto, ON , Canada
| | - Laura Murphy
- Pharmacy , University Health Network, University of Toronto , Toronto, ON , Canada
| | - Marisa Battistella
- Pharmacy , University Health Network, University of Toronto , Toronto, ON , Canada
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Abstract
Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis.
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Affiliation(s)
- Murat Yusuf Sav
- Department of Neurology, Special Tekden Hospital, Kayseri, Turkey
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14
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Affiliation(s)
- Morris Levin
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH
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15
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Harris TJ, Nazir R, Khetpal P, Peterson RA, Chava P, Patel SS, Kimmel PL. Pain, sleep disturbance and survival in hemodialysis patients. Nephrol Dial Transplant 2011; 27:758-65. [PMID: 21771748 DOI: 10.1093/ndt/gfr355] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients' perception of pain during hemodialysis (HD) and at times between HD treatment and its association with survival have not been well studied in end-stage renal disease (ESRD). We evaluated the experience of pain during HD and at times when the patient was not receiving HD, and assessed possible associations of the perception of pain and sleep disturbance with patient survival. METHODS A total of 128 ESRD patients treated with HD completed questionnaires on psychosocial status, quality of life and sleep disorders. A modified McGill Pain questionnaire was used to assess the nature, location, frequency, intensity and duration of pain both during and at times between HD sessions. The Pittsburgh Sleep Quality Index was used to screen for sleep disturbances over a 30-day period. RESULTS Controlling for age, diabetes mellitus, serum albumin concentration and human immunodeficiency virus infection, there was a significant association between mortality and both frequency and intensity of pain while patients were not on HD. There was no association between survival and duration of pain while off HD or any of the pain parameters while patients were on HD. There was no association between survival and the presence of a sleep disorder. CONCLUSIONS Pain perception while off HD may be of more importance to patients than pain during HD. The mechanisms underlying the association are unknown but may involve linkage of pain with severity of medical illness or the generation of a maladaptive cytokine response. Multicenter prospective studies of pain interventions using well-validated pain perception tools are needed to establish causal relationships. Interventions directed toward treating pain on non-HD days may improve ESRD patient survival.
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Affiliation(s)
- Tara J Harris
- Department of Medicine, George Washington University, Washington, DC, USA
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Masajtis-Zagajewska A, Pietrasik P, Krawczyk J, Krakowska M, Jarzębski T, Pietrasiewicz B, Zbróg Z, Nowicki M. Similar prevalence but different characteristics of pain in kidney transplant recipients and chronic hemodialysis patients. Clin Transplant 2010; 25:E144-51. [DOI: 10.1111/j.1399-0012.2010.01359.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cukor D, Kimmel PL. Education and end of life in chronic kidney disease: disparities in black and white. Clin J Am Soc Nephrol 2010; 5:163-6. [PMID: 20089490 DOI: 10.2215/cjn.09271209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shayamsunder AK, Patel SS, Jain V, Peterson RA, Kimmel PL. PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Sleepiness, Sleeplessness, and Pain in End-Stage Renal Disease: Distressing Symptoms for Patients. Semin Dial 2008; 18:109-18. [PMID: 15771654 DOI: 10.1111/j.1525-139x.2005.18218.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Symptoms are increasingly recognized as problematic for patients with end-stage renal disease (ESRD) treated with dialysis. Sleep disorders are common in ESRD patients treated with dialysis and are associated with patients' perceptions of quality of life, assessed by diverse measures, as well as depressive affect. Sleep disorders appear to be equally prevalent in peritoneal dialysis (PD) and hemodialysis (HD) patients. Treatment for sleep disorders in dialysis patients depends on establishing the diagnosis, often in a sleep laboratory, using polysomnography. Reversing coexistent medical and psychological disorders is important. The sleep apnea syndrome (SAS) can be treated with continuous positive airway pressure in dialysis patients, but conventional hemodialytic techniques have little effect on its severity. In contrast, nocturnal HD and transplantation appear to have important beneficial effects on sleep disordered breathing in ESRD patients. Although pain has been appreciated as a problem for ESRD patients for more than 20 years, few studies exist on this subject. Pain appears to be an underappreciated problem for ESRD patients. More research must be performed on the problem of pain in patients with chronic kidney disease (CKD).
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Affiliation(s)
- Archana K Shayamsunder
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC 20037, USA.
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Abstract
While there is a significant body of literature documenting the impairments in health-related quality of life (HRQOL) experienced by patients with end-stage renal disease (ESRD), recent work has helped to elucidate the mediators of impaired well-being in this patient group. Physical and emotional symptoms have been shown to be common, frequently severe, and directly linked with impaired HRQOL. The following review explores the process of symptom assessment in patients with chronic kidney disease (CKD), presents an overview of the composite burden and importance of symptoms in patients with ESRD, highlights particularly common and distressing symptoms for which existing treatment strategies may be applicable, and discusses future directions for efforts to address and alleviate symptoms in the growing population of patients who suffer from CKD.
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Affiliation(s)
- Steven D Weisbord
- Renal Section, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
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Goksel BK, Torun D, Karaca S, Karatas M, Tan M, Sezgin N, Benli S, Sezer S, Ozdemir N. Is Low Blood Magnesium Level Associated With Hemodialysis Headache? Headache 2006; 46:40-5. [PMID: 16412150 DOI: 10.1111/j.1526-4610.2006.00295.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH). BACKGROUND HDH has been recognized for many years, but the pathophysiology of this condition is not known. High arterial blood pressure, decreased serum osmolality, sodium washout, and high blood urea nitrogen level are reported risk factors for HDH. Low serum magnesium (Mg) level is known to cause some types of headache, including migraine (menstrual migraine in particular), tension-type headaches, and cluster and posttraumatic headaches. Low Mg has also been reported in HDH patients. METHODS A total of 250 hemodialysis (HD) patients were questioned about problems with headache. Of these, 75 were diagnosed with HDH according to the revised International Headache Society criteria for 2003. Eighty age- and sex-matched HD patients without HDH were selected as a control group. For each HDH and control subject, arterial diastolic and systolic blood pressure, body weight, and serum levels of sodium, blood urea nitrogen, creatinine, and Mg were measured before and after one HD session. Urea reduction rate and ultrafiltration were determined. Serum levels of phosphorus, calcium, albumin, and parathormone were measured only before the session. Findings in the HDH and control group were statistically compared. RESULTS As noted, 75 (30%) of the total 250 HD patients surveyed were diagnosed with HDH. The mean headache duration in this group was 5.17 +/- 5 hours. Vertex location, bilateral headache, dull nature, and moderate severity were the most prevalent features of HDH. There were no statistically significant differences between the HDH and control groups with respect to causes of end-stage renal disease. There were no significant differences between the HDH and control groups with respect to predialysis values for blood urea nitrogen, body weight, and arterial blood pressure (P > .05), and the same was true for comparisons of the postdialysis values for these parameters. The mean predialysis sodium level in the HDH group was higher than in the control group (P= .003). Both the mean predialysis and mean postdialysis Mg levels in the HDH group were significantly lower than the corresponding levels in the control group (P= .05 and P= .02, respectively). CONCLUSIONS The results suggest that low blood Mg level and high blood sodium level may be risk factors for HDH. Magnesium supplementation may help patients with HDH whose serum Mg levels are found to be low.
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Affiliation(s)
- Basak Karakurum Goksel
- Department of Neurology, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey
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Kimmel PL, Emont SL, Newmann JM, Danko H, Moss AH. ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity. Am J Kidney Dis 2004; 42:713-21. [PMID: 14520621 DOI: 10.1016/s0272-6386(03)00907-7] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent research suggests that patients' perceptions may be more important than objective clinical assessments in determining quality of life (QOL) for patients with end-stage renal disease (ESRD). METHODS We interviewed 165 hemodialysis patients from 3 sites using a QOL questionnaire that included the Satisfaction With Life Scale (SWLS) and the McGill QOL (MQOL) scale, which includes a single-item global measure of QOL (Single-Item QOL Scale [SIS]). The MQOL scale asks patients to report their most troublesome symptoms. We also initiated the use of a Support Network Scale and a Spiritual Beliefs Scale. RESULTS Mean patient age was 60.9 years, 52% were men, 63% were white, and 33% were African American. Patients had a mean treatment time for ESRD of 44 months, mean hemoglobin level of 11.8 g/dL (118 g/L), mean albumin level of 3.7 g/dL (37 g/L), and mean Kt/V of 1.6. Forty-five percent of patients reported symptoms. Pain was the most common symptom (21% of patients). There was an inverse relationship between reported number of symptoms and SWLS (P < 0.01), MQOL scale score (P < 0.001), and SIS (P < 0.001). The Spiritual Beliefs Scale correlated with the MQOL scale score, SWLS (both P < 0.01), and SIS (P < 0.05). The Support Network Scale score correlated with the MQOL Existential (P = 0.01) and MQOL Support (P < 0.01) subscales. No clinical parameter correlated with any measure of QOL, spiritual beliefs, or social support. CONCLUSION Symptoms, especially pain, along with psychosocial and spiritual factors, are important determinants of QOL of patients with ESRD. Additional studies, particularly a longitudinal trial, are needed to determine the reproducibility and utility of these QOL measures in assessing patient long-term outcome and their association with other QOL indices in larger and more diverse patient populations.
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Affiliation(s)
- Paul L Kimmel
- Department of Medicine, Division of Renal Diseases and Hypertension, George Washington University, Washington, DC, USA
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Abstract
BACKGROUND There is growing evidence that dialysis patients have a high burden of symptoms, including pain. However, the prevalence, cause, severity, and management of pain in dialysis patients have not been described. METHODS This prospective cohort study of 205 Canadian hemodialysis (HD) patients describes the prevalence, cause, severity, and management of pain in this population. A chart review for demographic and clinical data was conducted, and patients completed a questionnaire that incorporated the Brief Pain Inventory, followed by the McGill Pain Questionnaire. RESULTS One hundred three patients (50%) reported a problem with pain. Patients with pain had been on HD therapy longer (52.2 months) than those without pain (37.7 months). Causes of pain were diverse, and 18.4% of patients had more than a single cause of their pain. Musculoskeletal pain was most common (50.5%) and equal in severity to pain associated with peripheral neuropathy and peripheral vascular disease. Fifty-five percent of patients with pain rated their worst episode in the previous 24 hours as severe. Thirty-two percent of patients with pain were administered no analgesics, 29.1% were administered nonopioid analgesics, 26.2% were administered weak opioids, and 9.7% were administered strong opioids. The Pain Management Index describes the effectiveness of pain management and was negative in 74.8% of patients, indicating ineffective management. CONCLUSION Pain is a significant problem in more than 50% of HD patients and is not being effectively managed. The development of effective pain management strategies, underpinned by appropriate training and education, is necessary to improve the quality of life for dialysis patients.
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Affiliation(s)
- Sara N Davison
- Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
OBJECTIVE To determine the prevalence and clinical characteristics of headache in patients undergoing hemodialysis and to compare the prevalence of headache prior to and following the beginning of a hemodialysis program. BACKGROUND About 70% of patients receiving hemodialysis complain of headache. Despite this, headaches have not been well studied in this group of patients. METHODS We evaluated a series of patients with chronic renal failure who attended 3 hemodialysis services in a Brazilian town from January of 1998 to December of 1999. Patients with headache were prospectively followed and classified according to the International Headache Society criteria. The headaches were also categorized according to their temporal profile relative to hemodialysis. RESULTS Headache was reported by 87 (70.7%) of the 123 patients studied. Prior to beginning dialysis, 48% had migraine, 19% had episodic tension-type headache, and 8% had both. Headache related to arterial hypertension was the second most frequent headache diagnosis in these patients (25.4%). Fifty patients (57.5%) experienced headache during the session of hemodialysis. Thirty-four were classified as dialysis headache, 7 were classified as migraine, 7 as episodic tension-type headache, and 2 were unclassified. Twenty-four patients (27.6%) reported dramatic improvement of their headaches after the beginning of the dialysis program. CONCLUSIONS Headache is common in patients undergoing hemodialysis. Classification of such headaches according to the International Headache society criteria may be difficult.
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Affiliation(s)
- Ana L Antoniazzi
- Department of Neurology, School of Medicine at Ribeirão Preto, São Paulo University, Brazil
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Cagney KA, Wu AW, Fink NE, Jenckes MW, Meyer KB, Bass EB, Powe NR. Formal literature review of quality-of-life instruments used in end-stage renal disease. Am J Kidney Dis 2000; 36:327-36. [PMID: 10922311 DOI: 10.1053/ajkd.2000.8982] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although quality-of-life assessment is an important complement to conventional clinical evaluation, there are limited opportunities for researchers in end-stage renal disease (ESRD) to examine evidence for a range of quality-of-life measures. To better understand how quality of life has been conceptualized, measured, and evaluated for ESRD, we conducted a structured literature review. Eligible articles were identified from a MEDLINE search, expert input, and review of references from eligible articles. A standardized instrument was created for article review and included type of measure, instrument development process, study sample characteristics, quality-of-life domains, and reliability and validity testing. From 436 citations, 78 articles were eligible for final review, and of those, 47 articles contained evidence of reliability or validity testing. Within this set, there were 113 uses of 53 different instruments: 82% were generic and 18% were disease specific. Only 32% defined quality of life. The most frequently assessed domains were depression (41%), social functioning (32%), positive affect (30%), and role functioning (27%). Testing was completed for test-retest reliability (20%), interrater reliability (13%), internal consistency (22%), content validity (24%), construct validity (41%), criterion validity (55%), and responsiveness (59%). Few articles measuring quality of life in ESRD defined quality-of-life domains or adequately described instrument development and testing. Generic measures, such as the Sickness Impact Profile, and disease-specific measures, such as the Kidney Disease Questionnaire, had been tested more thoroughly than others. Standardized reporting and more rigorous testing could help researchers make informed choices about instruments that would best serve their own and their patients' needs.
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Affiliation(s)
- K A Cagney
- Department of Health Studies, University of Chicago, Chicago, IL, USA
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Sklar A, Newman N, Scott R, Semenyuk L, Schultz J, Fiacco V. Identification of factors responsible for postdialysis fatigue. Am J Kidney Dis 1999; 34:464-70. [PMID: 10469856 DOI: 10.1016/s0272-6386(99)70073-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ultrafiltration, diffusion, osmotic shifts, blood-membrane interactions, and psychological factors have all been implicated in the pathogenesis of postdialysis fatigue (PDF). To identify responsible factors, we performed a prospective, randomized, crossover analysis of fatigue scores (scale, 0 to 4) in 12 maintenance hemodialysis subjects with PDF. Fatigue scores were evaluated on nondialysis days (baseline) and after the following procedures on midweek treatment days: standard dialysis using either a 135- to 140-mEq/L sodium bath (routine hemodialysis) or a 150- to 155-mEq/L sodium bath (hypernatric hemodialysis); isolated ultrafiltration; isolated diffusion; and sham procedures with (isolated membrane) or without (recirculation) exposure to a dialysis membrane. Maximal fatigue scores are expressed as mean and 95% confidence intervals (CIs). The highest scores were recorded by patients who had just undergone routine hemodialysis (mean score, 2. 6; 95% CI, 1.7 to 3.4), isolated ultrafiltration (mean score, 2.1; 95% CI, 1.3 to 2.9), and isolated diffusion (mean score, 2.4; 95% CI, 1.5 to 3.2). There were no significant differences in fatigue scores between baseline periods and isolated membrane and recirculation procedures (mean score, 1.3; 95% CI, 0.4 to 2.2). Fatigue scores after hypernatric hemodialysis occupied an intermediate position (mean score, 1.7; 95% CI, 0.8 to 2.6). These results suggest that rapid hydraulic and molecular flux have a greater role in the pathogenesis of PDF than psychological stress and blood-membrane interactions. Use of a high-sodium bath may ameliorate PDF. We conclude that appropriate adjustments in both ultrafiltration and sodium profiling remain the most important means for controlling PDF in patients on short-duration hemodialysis.
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Affiliation(s)
- A Sklar
- Nutrition, United Health Services Hospitals, Binghamton, NY, USA.
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Griffin KW, Friend R, Kaell AT, Bennett RS, Wadhwa NK. Negative affect and physical symptom reporting: A test of explanatory models in two chronically ill populations. Psychol Health 1999. [DOI: 10.1080/08870449908407329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mactier RA, Sprosen TS, Gokal R, Williams PF, Lindbergh M, Naik RB, Wrege U, Gröntoft KC, Larsson R, Berglund J, Tranaeus AP, Faict D. Bicarbonate and bicarbonate/lactate peritoneal dialysis solutions for the treatment of infusion pain. Kidney Int 1998; 53:1061-7. [PMID: 9551418 DOI: 10.1111/j.1523-1755.1998.00849.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A randomized, double-blind, cross-over study was undertaken to determine the effects of novel bicarbonate (38 mM) and bicarbonate (25 mM)/lactate (15 mM) containing peritoneal dialysis (PD) solutions on infusion pain in patients who experienced inflow pain with conventional lactate (40 mM) solution. Pain was assessed using a verbal rating scale and the validated McGill Pain Questionnaire (MPQ). Eighteen patients were recruited to the study. Both novel solutions resulted in highly statistically significant reductions in inflow pain compared to the control lactate solution, as assessed with both the verbal rating scale and the MPQ. For all pain variables assessed, the bicarbonate/lactate solution was more effective than the bicarbonate solution in alleviating pain. In conclusion, both solutions reduced the infusion pain experienced with control solution, but the bicarbonate/lactate solution appears to be the most effective. In contrast to the most widespread current treatment, which is the manual injection of sodium bicarbonate, the bicarbonate/lactate solution does not have the associated increased risk of peritonitis.
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Affiliation(s)
- R A Mactier
- Stobhill Hospital, Glasgow, Scotland, United Kingdom
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Bremer BA, Haffly D, Foxx RM, Weaver A. Patients' perceived control over their health care: an outcome assessment of their psychological adjustment to renal failure. Am J Med Qual 1995; 10:149-54. [PMID: 7549597 DOI: 10.1177/0885713x9501000307] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Previous research has sometimes produced conflicting results regarding patients' psychological adjustment to end-stage renal disease (ESRD). It is generally accepted that treatment outcomes vary across treatment modality, with successful transplant patients reporting a higher subjective quality of life than patients on center hemodialysis. Hemodialysis and transplantation therapies vary in many ways, including the intrusiveness of treatment on all aspects of the patient's life. In the present study, 65 individuals being treated for ESRD with center hemodialysis or a renal transplant were assessed for health locus of control, for generalized control over 11 life dimensions, and for beliefs about control over specific aspects of treatment for ESRD. The study also included indicators of psychological adjustment. The results indicated that control over life dimensions, which includes control over illness, is a significant factor in psychological adjustment. Beliefs that one can comply specifically with diet and fluid restrictions were related to treatment outcome. These data suggest that interventions designed to increase patients' perception of control are likely to have a positive impact on the qualitative aspect of treatment.
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Affiliation(s)
- B A Bremer
- Psychology Program, Penn State Harrisburg, Middletown 17057, USA
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Devins GM. Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease. ADVANCES IN RENAL REPLACEMENT THERAPY 1994; 1:251-63. [PMID: 7614328 DOI: 10.1016/s1073-4449(12)80007-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Chronic life-threatening and disabling conditions, such as end-stage renal disease (ESRD), introduce significant psychosocial stressors and adaptive demands. The concept of illness intrusiveness is introduced to represent the illness-induced disruptions to lifestyle, activities, and interests that can compromise psychosocial well-being and contribute to emotional distress in chronic disease. A theoretical model is presented to specify the nature, determinants, and psychosocial consequences of illness intrusiveness and the causal pathways through which these factors are interrelated. Evidence in support of this analysis is reviewed and includes relevant findings from several chronic conditions including renal failure. The article concludes with suggested strategies and tactics for minimizing illness intrusiveness in ESRD. It is hoped that effective minimization of illness intrusiveness can assist affected individuals in achieving a high quality of life.
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Affiliation(s)
- G M Devins
- Clarke Institute, of Psychiatry, University of Toronto, Ontario, Canada
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Devins GM, Armstrong SJ, Mandin H, Paul LC, Hons RB, Burgess ED, Taub K, Schorr S, Letourneau PK, Buckle S. Recurrent pain, illness intrusiveness, and quality of life in end-stage renal disease. Pain 1990; 42:279-285. [PMID: 2250919 DOI: 10.1016/0304-3959(90)91140-e] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Repeated episodes of headache and muscle cramp were hypothesized to contribute to increased patient perceptions of illness intrusiveness and to compromised quality of life. Standard measures of pain, illness intrusiveness, and quality of life were obtained on 2 occasions, each 6 weeks apart, from 100 end-stage renal disease patients. The impact of recurrent muscle cramps on perceptions of illness intrusiveness was conditional upon the occurrence of headache symptoms. Perceptions of illness intrusiveness were significantly higher when both muscle cramp and headache symptoms occurred during one or more assessment intervals as compared to when muscle cramps or headaches, only, occurred. Illness-related concerns and general feelings of pessimism were also significantly higher among patients who experienced recurrent episodes of muscle cramp. Although no direct relations were observed between pain and other quality of life indicators, previous research has documented a relation between illness intrusiveness and quality of life. Recurrent pain problems, thus, appear to contribute to increased illness intrusiveness and to reduced quality of life in end-stage renal disease patients.
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Affiliation(s)
- Gerald M Devins
- Department of Psychology, University of Calgary, Calgary, AlbertaCanada Faculty of Medicine, University of Calgary, Calgary, AlbertaCanada Foothills Hospital, Calgary, AlbertaCanada
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Binik YM, Chowanec GD, Devins GM. Marital role strain, illness intrusiveness, and their impact on marital and individual adjustment in end-stage renal disease. Psychol Health 1990. [DOI: 10.1080/08870449008400394] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Data from three separate quality of life studies of end-stage renal disease patients investigated the hypothesis that those patients who have previously experienced the failure of a transplanted kidney are characterized by lower levels of life quality than are patients who have not. Multivariate data analyses uniformly failed to support this hypothesis. Likely explanations for the discrepancy between these and other contradictory findings as well as clinical and research implications are presented.
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Abstract
Analgesic drug abuse led to end-stage renal disease in 31% of 122 patients in a cross-sectional investigation at our center. Addiction to analgesics and tranquilizers remained a serious problem in these patients even after they were placed on chronic hemodialysis. There is strong evidence that drug addiction leading to end-stage renal disease and chronic hemodialysis correlates with a special type of personality typified by the 60-year-old depressive woman suffering from chronic headache.
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Affiliation(s)
- Frieder Keller
- Freie Universität, Klinikum Steglitz, Medizinische Klinik Nephrologie, Dialysezentrum des KfH, Hindenburgdamm 30, 1000 Berlin 45 F.R.G
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Affiliation(s)
- M. Zetin
- University of California Irvine Medical Center 101 City Drive South, Route 88 Orange, CA. 92668, U.S.A
| | - J. Dietch
- University of California Irvine Medical Center 101 City Drive South, Route 88 Orange, CA. 92668, U.S.A
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