End-stage renal disease (ESRD) is a common chronic disease worldwide that requires hemodialysis. Patients may face chronic pain and poor quality of life. Therefore, a better understanding of these variables in hemodialysis patients is essential to provide a good intervention. We aim to determine how common chronic pain is in hemodialysis patients and its correlation with sociodemographics, C-reactive protein (CRP), calcium, phosphorus, albumin, and parathyroid hormone. A cross-sectional study of hemodialysis patients was conducted in Palestine. Data collection took place between November 2020 and May 2021. We used the brief pain inventory score to assess chronic pain, and lab tests detected CRP levels. Data were collected using a convenience sampling technique. There were two hundred sixty-one patients in the present study. The mean age of the patients was 51 years, with 63.6% being men. 47.1% of them reported having chronic pain. Gender (p = 0.011), social status (p = 0.003), educational status (p = 0.010), and number of chronic diseases (p = 0.004) indicated a significant relationship with the severity score of pain. Furthermore, sex (p = 0.011), social status (p = 0.003), and number of chronic diseases (p = 0.002) were significantly associated with the pain interference score. Additionally, Person’s test indicated significant correlations between CRP and pain severity (p < 0.001) and with pain interference (p < 0.001). Albumin was significantly and negatively correlated with pain severity (p = 0.001) and pain interference (p < 0.001). Multiple linear regression analysis revealed that patients who had a higher CRP level and many chronic diseases were more likely to have a higher pain severity score. However, pain severity was the only predictor for pain interference. Our results suggest that there is a significant correlation between the existence of chronic pain in hemodialysis patients and increased CRP levels. However, further investigations are needed with a larger number of patients in more than one dialysis unit to confirm this correlation and management of chronic pain in patients with HD.

End-stage renal disease (ESRD) or chronic kidney disease (CKD) is a term that refers to all stages of renal impairment, from damaged at risk to mild, moderate, and severe chronic kidney failure¹. Patients with CKD receive integrated care, including kidney replacement therapy (KRT), which can be dialysis or kidney replacement, and non-KRT conservative care². Almost 90% of patients receiving hemodialysis (HD) are considered the most common kind of KRT³. Hemodialysis is used primarily to treat acute and chronic renal failure that has not responded to conventional medical therapy⁴. Despite the great importance of hemodialysis in treating ESKD, hemodialysis has many side effects in these patients. Patients who receive chronic hemodialysis sessions regularly may develop a range of consequences, including intradialytic cardiovascular instability, malnutrition, and vascular access problems⁴. Furthermore, there is growing evidence of the correlation between hemodialysis and chronic pain among these patients⁵.

Pain is described as a physically or emotionally uncomfortable experience that can lead to impotence, low physical activity, anxiety, and interruptions in tasks and social relationships⁶. Pain in patients with HD is usually moderate to severe. Neuropathic, visceral, somatic, neuropathic, nociceptive, and complicated regional pain syndromes are all factors that contribute to pain⁷. A study in patients with HD showed that 55% had severe pain in the previous day, and three-quarters of them reported inadequate pain management⁵. Psychological difficulties, disturbed sleep, lower dialysis compliance, and a decreased quality of life can all be due to inadequately controlled pain in patients with HD^8,9,10. In addition, chronic pain was reported to be strongly associated with all-cause mortality in CKD patients¹¹.

C-reactive protein (CRP) is an indicator of the underlying inflammatory process in ESRD; it is also a precise objective measure of inflammatory activity, accurately reflecting the production of proinflammatory cytokines, including tumor necrosis factor-a (TNF-a) and interleukin (IL-6)¹². Importantly, disturbed parameters such as calcium, vitamin, parathyroid hormone, and CRP were significantly related to chronic pain in patients with HD¹³. However, certain articles did not show a significant difference in the level of CRP between patients with/without pain^10,11. These debates urge the need to explore more about this issue, as recommended by a recent study¹⁰.

Some studies on HD patients in Palestine were conducted and published regarding the use of complementary and alternative medicaine and the quality of life of this population^14,15. Nevertheless, no single study has emphasized the prevalence of chronic pain in hemodialysis patients and its correlation with reactive protein. Therefore, the primary aim of the current study was to clinically describe HD patients, detect the prevalence of chronic pain among them, and determine the variables influencing the prevalence of chronic pain in hemodialysis patients. In addition, our secondary aim was to detect whether there is a correlation between laboratory tests (CRP, albumin, phosphorus, calcium, and parathyroid hormone (PTH)) and chronic pain.

This research will help to conduct further research on hemodialysis patients with chronic pain and to provide recommendations that can help hemodialysis patients control chronic pain, which leads to a higher quality of life. Furthermore, this study will provide new data on the value of chronic pain among hemodialysis patients and its relationship with CRP levels, which will help better understand the factors that affect chronic pain in patients with HD.

Title

Scientific Reports

Publisher

An-Najah National University

Publisher Country

Palestine

Indexing

Thomson Reuters

Impact Factor

4.99

Publication Type

Online only

Volume

13

Year

2023

Pages

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