Abstract: FR-OR48
Practice Patterns for Patient Pain Control and Outcomes Among CKD Patients: A CKDopps Analysis
Session Information
- Interventions to Reduce CKD Progression
November 03, 2023 | Location: Room 119, Pennsylvania Convention Center
Abstract Time: 05:33 PM - 05:42 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Nair, Nikhil, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Guedes, Murilo Henrique, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Alencar de Pinho, Natalia, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Tu, Charlotte, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Reichel, Helmut, Scientific Institute for Nephrology, Dusseldorf, Germany
- Argyropoulos, Christos, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Raina, Rupesh, Akron Children's Hospital, Akron, Ohio, United States
Background
Chronic kidney disease (CKD) patients often suffer from poorly managed pain. Opioid and analgesic abuse is of concern. This study examines international pain management practices for non-dialysis-dependent CKD patients and the association between pain and patient-reported outcomes.
Methods
Data from the CKD Outcomes and Practice Patterns Study, a cohort of Stage 3-5 CKD patients from Brazil, France, Germany, and the US, were analyzed. Self-reported pain was assessed using the Kidney Disease Quality of Life Short Form, and analgesic prescriptions were categorized. Outcomes included depression, functional status, health-related quality of life and prescription practices.
Results
The study included 4,160 patients. A majority reported some degree of pain interference, with levels varying with CKD stage and country. Extreme pain was associated with eGFR and higher BMI. Analgesic prescriptions, notably NSAIDs and opioids, were most frequent in the US followed by Germany, Brazil and France. Pain levels were directly associated with poorer health-related quality of life, with patients reporting lower general health, physical function, and emotional well-being. Patients who were prescribed analgesics reported similar levels of health-related quality of life to those not prescribed. Patients prescribed analgesics were more often females, had lower eGFR, slightly higher BMI, and were more commonly diagnosed with cardiovascular and psychiatric disorders.
Conclusion
The results highlight a significant pain burden in CKD patients and variations in international pain management practices. The findings emphasize the importance of improved pain management strategies in CKD care, necessitating comprehensive pain assessment, patient education, and consideration of pharmacokinetic alterations due to CKD. Consensous pain management guidlines and discussions are imperative.
Table 1. Prevalence of analgesics prescription by country and CKD stage
| Brazil | France | Germany | US | |||||||||
| Stage 3 | Stage 4 | Stage 5 | Stage 3 | Stage 4 | Stage 5 | Stage 3 | Stage 4 | Stage 5 | Stage 3 | Stage 4 | Stage 5 | |
| N | 192 | 326 | 114 | 1594 | 1247 | 118 | 584 | 1807 | 17 | 640 | 1081 | 272 |
| Any Analgesic | 40% | 48% | 40% | 24% | 24% | 21% | 11% | 13% | 6% | 17% | 18% | 24% |
| Opioid | 0.6% | 0.3% | 0% | 7% | 6% | 6% | 11% | 13% | 6% | 17% | 18% | 24% |
| NSAID | 39% | 47% | 40% | 2% | 1% | 1% | 13% | 12% | 0% | 54% | 52% | 44% |
| Other | 1% | 1% | 3% | 19% | 20% | 17% | 17% | 21% | 24% | 8% | 11% | 8% |