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Kidney Week

Abstract: PO0548

Prospective Study of Patient-Reported Outcomes After Endovascular Renal Ablation in Individuals with Chronic Kidney Pain and Opiate Use

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Lopez, Victor A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Deshmukh, Abhishek, Mayo Clinic Dpt of Cardiovascular Medicine, Rochester, Minnesota, United States
  • Gulati, Rajiv, Mayo Clinic Dpt of Cardiovascular Medicine, Rochester, Minnesota, United States
  • Novotny, Paul, Mayo Clinic Biomedical Statistics and Informatics, Rochester, Minnesota, United States
  • Hogan, Marie C., Mayo Clinic Dpt of Neph & HTN Research, Rochester, Minnesota, United States
Background

Endovascular renal ablation (ERA) may be useful for palliating and in some instances relieving refractory kidney pain (RKP) but is not widely available. We report our experience of ERA in 20 patients with RKP.

Methods

We conducted a prospective study of patient-reported outcomes pre and post ERA for RKP. Baseline & subsequent pain questionnaires (McGill Pain (MPQ), Brief Pain Inventory (BPI), Opioid oral morphine milligrams equivalent (MME)) & QOL (LASA-6, PHQ-9 & SF-8) were obtained. The Wilcoxon test was used. ERA using an open irrigated ablation catheter was performed in a spiral manner distal to proximal upto the renal artery ostium. Power was titrated between 5-30 watts guided by change in impedance.

Results

We performed 24 ERA (3 bilateral, 21 unilateral; 4 redos) in 20 patients, female:male; 14:6; median age 40yr. 12 patients (60%) had Loin Pain Hematuria Syndrome(LPHS), 4 (20%) ADPKD, and others 4 (20%). 17 of 20 have completed the baseline questionnaires & 9 of 17 patients have 6mo data. All nine experienced variable or complete reductions in pain & QOL from baseline to 6mo (Table1). A median of 8mo pain relief was reported. After their first ERA, responders (pain relief >6mo) median 8.5mo (n=12/20;60%) while 4 (20%) reported pain relief <6mo (non-responders) median 2mo. 3 (15%) had no relief, and 1 was lost to FU. In the redo ERA, there was no relief in 2; in 1 pain relief lasted 4mo (non-responder), and in the other, relief was 8mo (responder). Following the first ERA, MME decreased by ≥30% in 6, increased in 7 (≥30% in 6;15% in 1), was unchanged in 3, and no data was available in 4. There were 3 access site hematomas, one acute renal artery dissection (procedure related) requiring stents & one renal artery stenosis (5mo later) treated by percutaneous transluminal angioplasty but subsequent reduced kidney function.

Conclusion

Among patients with RKP undergoing ERA, half achieved objective improvement in pain & QOL at 6 mo. Prospective randomized studies with careful patient selection are required to assess the the role of ERA for palliation of pain.

Assessments of Pain & QOL
Tool




BPI
(Pain)






SF-8



LASA-6
Improved outcome

Pain perception
General Interference
Mood Interference
Walking interference
Activity interference
Relations interference
Enjoyment interference
Overall Interference

Physical Function
Role Physical
Social Function
Role Emotional
Physical Composite

Physical Well-Being
Baseline N=17

5.7
6.2
6.1
4.3
6.6
5.3
7.1
6.1

34.4
32.1
33.8
37.7
29.6

4.1
6 months N=9

3.1
3.1
3.6
3.7
2.8
2.8
4.4
3.2

12.8
12.4
12.6
9.4
13.4

3.3
p value

0.02
0.03
0.01
0.01
0.02
0.01
0.02
0.01

0.01
0.01
0.02
0.03
0.01

0.002