Pain, sleep disturbance and survival in hemodialysis patients

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...

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Bibliographic Details
Published in:	Nephrology, dialysis, transplantation Vol. 27; no. 2; pp. 758 - 765
Main Authors:	HARRIS, Tara J, NAZIR, Racha, KHETPAL, Prashant, PETERSON, Rolf A, CHAVA, Priyanka, PATEL, Samir S, KIMMEL, Paul L
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-02-2012
Subjects:	Adult Age Distribution Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Chi-Square Distribution Cross-Sectional Studies Depression - diagnosis Depression - epidemiology Depression - psychology Emergency and intensive care: renal failure. Dialysis management Female Follow-Up Studies Glomerulonephritis Humans Intensive care medicine Kaplan-Meier Estimate Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - mortality Kidney Failure, Chronic - psychology Kidney Failure, Chronic - therapy Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Original Pain - diagnosis Pain - epidemiology Pain Measurement Pain Threshold Proportional Hazards Models Quality of Life Renal Dialysis - methods Renal Dialysis - mortality Renal Dialysis - psychology Risk Assessment Severity of Illness Index Sex Distribution Sickness Impact Profile Sleep Wake Disorders - diagnosis Sleep Wake Disorders - epidemiology Sleep Wake Disorders - psychology Socioeconomic Factors Stress, Psychological Surveys and Questionnaires Survival Rate Young Adult Human Kidney disease chronic kidney disease Urinary system disease satisfaction with care Hemodialysis Survival Extrarenal dialysis Pain Sleep satisfaction with life Renal failure psychosocial depression
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Summary:	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. 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. 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. 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.
ISSN:	0931-0509 1460-2385
DOI:	10.1093/ndt/gfr355