Depressive Symptoms Predict the Subsequent Risk of Bodily Pain in Dialysis Patients: Japan Dialysis Outcomes and Practice Patterns Study

Inverse Association Between Persistence With Antidepressant Medication and Onset of Chronic Pain in Patients With Depression: A Retrospective Cohort Study

PURPOSE/BACKGROUND

Despite the known involvement of depression in chronic pain, the association between persistence with and adherence to antidepressant medication and onset of chronic pain in patients with depression remains unclear.

METHODS/PROCEDURES

This retrospective cohort study used a Japanese claims database to extract data for adult patients with depression who were prescribed antidepressants between April 2014 and March 2020. Patients were divided into groups according to duration of continuous prescription of antidepressants (≥6 months [persistent group] and <6 months [nonpersistent group]) and medication possession ratio (≥80% [good adherence group] and <80% [poor adherence group]). The outcome was onset of chronic pain, which was defined as continuous prescription >3 months of analgesics and diagnosis of pain-related condition after discontinuation of the first continuous antidepressant prescription. The risk of onset of chronic pain was compared between the paired groups.

FINDINGS/RESULTS

A total of 1859 patients were selected as the study population and categorized as the persistent (n = 406) and nonpersistent (n = 1453) groups, and good adherence (n = 1551) and poor adherence (n = 308) groups. Risk of onset of chronic pain was significantly lower in the persistent group than in the nonpersistent group after controlling for confounding via standardized mortality ratio weighting (hazard ratio, 0.38; 95% confidence interval, 0.18-0.80; P = 0.011). There was no significant difference between the good and poor adherence groups.

IMPLICATIONS/CONCLUSIONS

Antidepressant persistence for ≥6 months is recommended and may reduce the onset of chronic pain in patients with depression.

Contemporary English Pain Descriptors as Detected on Social Media Using Artificial Intelligence and Emotion Analytics Algorithms: Cross-sectional Study

BACKGROUND

Pain description is fundamental to health care. The McGill Pain Questionnaire (MPQ) has been validated as a tool for the multidimensional measurement of pain; however, its use relies heavily on language proficiency. Although the MPQ has remained unchanged since its inception, the English language has evolved significantly since then. The advent of the internet and social media has allowed for the generation of a staggering amount of publicly available data, allowing linguistic analysis at a scale never seen before.

OBJECTIVE

The aim of this study is to use social media data to examine the relevance of pain descriptors from the existing MPQ, identify novel contemporary English descriptors for pain among users of social media, and suggest a modification for a new MPQ for future validation and testing.

METHODS

All posts from social media platforms from January 1, 2019, to December 31, 2019, were extracted. Artificial intelligence and emotion analytics algorithms (Crystalace and CrystalFeel) were used to measure the emotional properties of the text, including sarcasm, anger, fear, sadness, joy, and valence. Word2Vec was used to identify new pain descriptors associated with the original descriptors from the MPQ. Analysis of count and pain intensity formed the basis for proposing new pain descriptors and determining the order of pain descriptors within each subclass.

RESULTS

A total of 118 new associated words were found via Word2Vec. Of these 118 words, 49 (41.5%) words had a count of at least 110, which corresponded to the count of the bottom 10% (8/78) of the original MPQ pain descriptors. The count and intensity of pain descriptors were used to formulate the inclusion criteria for a new pain questionnaire. For the suggested new pain questionnaire, 11 existing pain descriptors were removed, 13 new descriptors were added to existing subclasses, and a new Psychological subclass comprising 9 descriptors was added.

CONCLUSIONS

This study presents a novel methodology using social media data to identify new pain descriptors and can be repeated at regular intervals to ensure the relevance of pain questionnaires. The original MPQ contains several potentially outdated pain descriptors and is inadequate for reporting the psychological aspects of pain. Further research is needed to examine the reliability and validity of the revised MPQ.

Psychological distress between chronic hemodialysis patients with and without low back pain

OBJECTIVE

The aim of this study was to compare psychological distress between patients on chronic hemodialysis with and without chronic low back pain (CLBP).

SUBJECTS AND METHODS

A total of 72 patients on chronic hemodialysis, aged 72.9 ± 10.8 years, were enrolled in this cross-sectional study. Psychological distress using the K6, questionnaire for CLBP, and physical activity using the tri-accelerometer were evaluated.

RESULTS

Twenty-nine patients (40.3 %) were having CLBP. The K6 scores were 4.0 ± 4.6 and physical activity (n = 55) was 1.0 ± 1.0 METs h/day. K6 scores in patients on chronic hemodialysis with CLBP were significantly higher than those in patients on chronic hemodialysis without CLBP even after adjusting for sex, age, duration of hemodialysis and physical activity.

CONCLUSION

These results suggest that higher psychological distress was a fundamental feature in patients on chronic hemodialysis with CLBP.

Dialysis Headache: A Narrative Review

BACKGROUND

Patients with chronic kidney disease who need dialysis often have poor quality of life. Dialysis headache is a frequent complication of hemodialysis and is often a challenge for nephrologists, neurologists, and headache specialists.

METHOD

This was a narrative review.

RESULTS

The prevalence of dialysis headache varies between 27% and 73%. Among the characteristics of this headache are the pulsatile pattern, frontal location, moderate to severe intensity, and onset a few hours after the beginning of dialysis. The headache may be accompanied by nausea and vomiting. The physiopathology of hemodialysis headache is still not completely understood. Some factors that seem to be associated with it are variations in urea, sodium, magnesium, blood pressure, and weight levels. The hematoencephalic barrier has an important role. Variations in electrolyte and urea levels occur in the systemic circulation during hemodialysis, but the cerebral concentrations of these substances are stable over the first few hours of the procedure. The flow of free water through the hematoencephalic barrier may lead to cerebral edema. Other potential pathophysiological factors include nitric oxide, calcitonin gene-related peptide, and substance P. There are recommendations for maintenance of volume and control over electrolytes and blood pressure and avoidance of caffeine for prevention of hemodialysis headache. However, there are no controlled studies of prophylactic or abortive hemodialysis headache treatment.

CONCLUSION

Despite its prevalence, hemodialysis headache has been poorly studied, thus making it difficult to understand the pathophysiological mechanisms involved in its genesis. Current clinical management practices are therefore necessarily empiric with minimal to no evidence base.

Chronic pelvic pain in women: an epidemiological perspective

Chronic pelvic pain (CPP) is common in women of reproductive age and has a significant impact on quality of life, work efficiency and healthcare utilization. CPP can be a manifestation of many different, often multifactorial conditions, and in the absence of an identified cause, the management can be particularly challenging. High quality epidemiological studies would improve the understanding of CPP and identify risk factors which may be targeted for the development of appropriate management strategies. This review focuses on what is known about the prevalence, risk factors, individual and societal burden of CPP and outlines important management strategies.

Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines.

Hemodialysis-related headache

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.

Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies

Prevalence estimates of depression in chronic kidney disease (CKD) vary widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with CKD. We searched MEDLINE and Embase (through January 2012). Random-effects meta-analysis was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. We included 249 populations (55,982 participants). Estimated prevalence of depression varied by stage of CKD and the tools used for diagnosis. Prevalence of interview-based depression in CKD stage 5D was 22.8% (confidence interval (CI), 18.6-27.6), but estimates were somewhat less precise for CKD stages 1-5 (21.4% (CI, 11.1-37.2)) and for kidney transplant recipients (25.7% (12.8-44.9)). Using self- or clinician-administered rating scales, the prevalence of depressive symptoms for CKD stage 5D was higher (39.3% (CI, 36.8-42.0)) relative to CKD stages 1-5 (26.5% (CI, 18.5-36.5)) and transplant recipients (26.6% (CI, 20.9-33.1)) and suggested that self-report scales may overestimate the presence of depression, particularly in the dialysis setting. Thus, interview-defined depression affects approximately one-quarter of adults with CKD. Given the potential prevalence of depression in the setting of CKD, randomized trials to evaluate effects of interventions for depression on patient-centered outcomes are needed.

Burden and management of chronic kidney disease in Japan: systematic review of the literature

Background

Chronic kidney disease (CKD) is a common disorder with increasing prevalence worldwide. This systematic literature review aims to provide insights specific to Japan regarding the burden and treatment of CKD.

Methods

We reviewed English and Japanese language publications from the last 10 years, reporting economic, clinical, humanistic, and epidemiologic outcomes, as well as treatment patterns and guidelines on CKD in Japan.

Results

This review identified 85 relevant articles. The prevalence of CKD was found to have increased in Japan, attributable to multiple factors, including better survival on dialysis therapy and a growing elderly population. Risk factors for disease progression differed depending on CKD stage, with proteinuria, smoking, hypertension, and low levels of high-density lipoprotein commonly associated with progression in patients with stage 1 and 2 disease. Serum albumin levels and hemoglobin were the most sensitive variables to progression in patients with stage 3 and 5 disease, respectively. Economic data were limited. Increased costs were associated with disease progression, and with peritoneal dialysis as compared with either hemodialysis or combination therapy (hemodialysis + peritoneal dialysis) treatment options. Pharmacological treatments were found potentially to improve quality of life and result in cost savings. We found no reports of treatment patterns in patients with early-stage CKD; however, calcium channel blockers were the most commonly prescribed antihypertensive agents in hemodialysis patients. Treatment guidelines focused on anemia management related to dialysis and recommendations for peritoneal dialysis treatment and preventative measures. Few studies focused on humanistic burden in Japanese patients; Japanese patients reported greater disease burden but better physical functioning compared with US and European patients.

Conclusion

A dearth of evidence regarding the earlier stages of kidney disease presents an incomplete picture of CKD disease burden in Japan. Further research is needed to gain additional insight into CKD in Japan.

Depression, insomnia and sleep apnea in patients on maintenance hemodialysis

Depression and sleep disorders are more frequent in patients on maintenance hemodialysis (HD) than the general population, and are associated with reduced quality of life and increased mortality risk. The purpose of this study was to assess the prevalence of depression, sleep apnea, insomnia in patients on HD as well as depression in their primary caregiver and to correlate these with the demographic profile. A cross-sectional study was conducted among 69 patients on maintenance HD for more than 3 months. There was high p revalence of depression (47.8%), insomnia (60.9%), increased risk of sleep apnea (24.6%) and depression in caregiver (31.9%). Depression was significantly more in patients with low monthly income (P=0.03), those on dialysis for more than 1 year (P=0.001) and the unemployed (P=0.009). High-risk patients for sleep apnea tended to be males with low monthly income (P=0.02). Insomnia was significantly higher in patients who were on dialysis for more than 1 year (P=0.003).

[The role of psychological interventions in dialysis: an exploratory study]

Patients suffering from end-stage renal disease (ESRD) have a very reduced quality of life accompanied by a severe emotional distress (high worries-anxiety-depression). However, in Belgium, no regular psychological intervention is proposed to dialyzed patients. Our objective is to show that psychological intervention can significantly decrease the emotional distress of patients with ESRD. Eleven sessions of structured interventions are proposed to ESRD patients. Eligibility criteria are to be major, to not present confusion or/and dementia, to have been on dialysis treatment for at least 3months, to have obtained 14 or more on HAD-scale. Interventions carry on the management of anxious and depressive symptoms and of the disease itself. This constitutes three independent modules. Questionnaires are filled in by the patients at various stages to evaluate the anxiety and the depression (HADS), the worries (Penn State) and the quality of life (KDQoL-SF). Results for the 47 ESRD patients show a significant reduction of the scores of anxiety, depression and worries and a significant growth of quality of life. In parallel, a decrease in the serum calcium-phosphorus product analyzed before dialysis has been noted.

Depression and cognitive function in maintenance hemodialysis patients

BACKGROUND

Both depression and cognitive impairment are common in hemodialysis patients, are associated with adverse clinical outcomes, and place an increased burden on health care resources.

STUDY DESIGN

Cross-sectional cohort.

SETTING & PARTICIPANTS

241 maintenance hemodialysis patients in the Boston, MA, area.

PREDICTOR

Depressive symptoms, defined as a Center for Epidemiological Studies Depression Scale (CES-D) score ≥16.

OUTCOME

Performance on a detailed neurocognitive battery.

RESULTS

Mean age was 63.8 years, 49.0% were women, 21.6% were African American, and median dialysis therapy duration was 13.8 months. There were 57 (23.7%) participants with significant depressive symptoms. In multivariable analysis adjusting for age, sex, education, and other comorbid conditions, participants with and without depressive symptoms performed similarly on the Mini-Mental State Examination (P = 0.4) and tests of memory. However, participants with greater depressive symptoms performed significantly worse on tests assessing processing speed, attention, and executive function, including Trail Making Test B (P = 0.02) and Digit-Symbol Coding (P = 0.01). Defining depression using a CES-D score ≥18 did not substantially change results.

LIMITATIONS

Cross-sectional design, absence of brain imaging.

CONCLUSIONS

Hemodialysis patients with a greater burden of depressive symptoms perform worse on tests of cognition related to processing speed and executive function. Further research is needed to assess the effects of treating depressive symptoms on cognitive performance in dialysis patients.