Prevalence of Neuropathic Pain and Associated Risk Factors in Hemodialysis Patients: A Cross-Sectional Study
DOI:
https://doi.org/10.58600/eurjther2883Keywords:
Chronic Kidney Disease, hemodialysis, Peripheral neuropathy, prevalence, risk factorAbstract
Objective: Chronic kidney disease (CKD) is associated with numerous systemic complications. Neuropathic pain is a significant neurological problem that affects quality of life. Neuropathic pain is an understudied complication in CKD patients undergoing hemodialysis treatment. In our study, we aimed to evaluate the prevalence of neuropathic pain in hemodialysis patients and the associated risk factors.
Methods: This cross-sectional study was carried out at Ankara Etlik City Hospital between January and December 2024. We enrolled 141 adult patients who had been on maintenance hemodialysis for at least six months. Neuropathic pain was screened using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, with a cutoff score of ≥12 indicating neuropathic pain. Information on sociodemographic profile, clinical characteristics, dialysis duration, duration of chronic kidney disease, comorbid conditions, and lifestyle habits was systematically recorded. A multivariable logistic regression model was constructed to identify factors independently associated with the presence of neuropathic pain.
Results: Neuropathic pain according to the LANSS scale was identified in 70 patients (49.6%). Patients with neuropathic pain had significantly longer hemodialysis duration (median 96 vs. 14 months, p < 0.001) and CKD duration (median 144 vs. 48 months, p < 0.001). Polypharmacy (67.1% vs. 39.4%, p = 0.001) and current smoking (40.0% vs. 16.9%, p = 0.002) were more common in the neuropathic pain group. Multivariate analysis revealed prolonged hemodialysis duration (OR 1.151, 95% CI 1.063–1.247, p < 0.001), longer CKD duration (OR 1.032, 95% CI 1.003–1.062, p = 0.047), polypharmacy (OR 9.06, 95% CI 5.536–15.322, p = 0.010), and smoking (OR 2.359, 95% CI 1.159–3.494, p = 0.024) as independent predictors.
Conclusion: Neuropathic pain is highly prevalent among hemodialysis patients and is strongly associated with longer disease and treatment duration, polypharmacy, and smoking. Routine screening for neuropathic pain, which negatively impacts quality of life and clinical outcomes, should focus on modifiable risk factors such as careful medication management and smoking cessation.
References
[1] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024) KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 105(4S):S117–S314. https://doi.org/10.1016/j.kint.2023.10.018
[2] Evans M, Lewis RD, Morgan AR, Whyte MB, Hanif W, Bain SC, Davies S, Dashora U, Yousef Z, Patel DC, Strain WD (2022) A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Adv Ther. 39(1):33–43. https://doi.org/10.1007/s12325-021-01927-z
[3] Krishnan AV, Kiernan MC (2009) Neurological Complications of Chronic Kidney Disease. Nat Rev Neurol. 5(10):542–551. https://doi.org/10.1038/nrneurol.2009.138
[4] Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN (2017) Neuropathic Pain. Nat Rev Dis Primers. 3:17002. https://doi.org/10.1038/nrdp.2017.2
[5] Lambourg E, Colvin L, Guthrie G, Murugan K, Lim M, Walker H, Boon G, Bell S (2021) The Prevalence of Pain Among Patients with Chronic Kidney Disease Using Systematic Review and Meta-analysis. Kidney Int. 100(3):636–649. https://doi.org/10.1016/j.kint.2021.03.041
[6] Arnold R, Issar T, Krishnan AV, Pussell BA (2016) Neurological Complications in Chronic Kidney Disease. JRSM Cardiovasc Dis. 5:2048004016677687. https://doi.org/10.1177/2048004016677687
[7] Pham PC, Toscano E, Pham PM, Pham PA, Pham SV, Pham PT (2009) Pain Management in Patients with Chronic Kidney Disease. NDT Plus.2(2):111–118. https://doi.org/10.1093/ndtplus/sfp001
[8] Koncicki HM, Unruh M, Schell JO (2017) Pain Management in CKD: A Guide for Nephrology Providers. Am J Kidney Dis. 69(3):451–460. https://doi.org/10.1053/j.ajkd.2016.08.039
[9] Pham PC, Khaing K, Sievers TM, Pham PM, Miller JM, Pham SV, Pham PA, Pham PT (2017) 2017 Update on Pain Management in Patients with Chronic Kidney Disease. Clin Kidney J. 10(5):688–697. https://doi.org/10.1093/ckj/sfx080
[10] Issar T, Arnold R, Kwai NCG, Walker S, Yan A, Borire AA, Poynten AM, Pussell BA, Endre ZH, Kiernan MC, Krishnan AV (2019) Relative Contributions of Diabetes and Chronic Kidney Disease to Neuropathy Development in Diabetic Nephropathy Patients. Clin Neurophysiol. 130(11):2088–2095. https://doi.org/10.1016/j.clinph.2019.08.005
[11] Kitala-Tańska K, Kania-Zimnicka E, Tański D, Kwella N, Stompór T, Stompór M (2024) Prevalence and Management of Chronic Pain, Including Neuropathic Pain, in Dialysis Patients with End-stage Renal Disease. Med Sci Monit. 30:e943808. https://doi.org/10.12659/MSM.943808
[12] Freeman R (2009) Not all Neuropathy in Diabetes is of Diabetic Etiology: Differential Diagnosis of Diabetic Neuropathy. Curr Diab Rep. 9(6):423–431. https://doi.org/10.1007/s11892-009-0069-7
[13] Watson JC, Dyck PJ (2015) Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management. Mayo Clin Proc. 90(7):940–951. https://doi.org/10.1016/j.mayocp.2015.05.004
[14] Bennett M (2001) The LANSS Pain Scale: the Leeds Assessment of Neuropathic Symptoms and Signs. Pain. 92(1-2):147-157. https://doi.org/10.1016/s0304-3959(00)00482-6
[15] Koç ER (2008). Validity and Reliability of the Turkish Version of the Self-Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS). Medical Specialty Thesis, Kırıkkale University, Turkey.
[16] Aggarwal HK, Sood S, Jain D, Kaverappa V, Yadav S (2013) Evaluation of Spectrum of Peripheral Neuropathy in Predialysis Patients with Chronic Kidney Disease. Ren Fail. 35(10):1323–1329. https://doi.org/10.3109/0886022X.2013.828261
[17] Jasti DB, Mallipeddi S, Apparao A, Vengamma B, Sivakumar V, Kolli S (2017) A Clinical and Electrophysiological Study of Peripheral Neuropathies in Predialysis Chronic Kidney Disease Patients and Relation of Severity of Peripheral Neuropathy with Degree of Renal Failure. J Neurosci Rural Pract. 8(4):516-524. https://doi.org/10.4103/jnrp.jnrp_186_17
[18] Aatif T, Labioui N, Laasli H, Zajjari Y, Kabbaj DE (2025) Uremic Peripheral Neuropathy in Nondiabetic Chronic Hemodialysis Patients. Ann Indian Acad Neurol. 28(4):590–593. https://doi.org/10.4103/aian.aian_74_25
[19] Hassan MAS, Mohamed MG (2021) Peripheral Neuropathy Burden in Hemodialysis and Liver Cirrhosis in a Sample of Egyptian Patients. Int J Med Arts. 3(2): 1266-1273. https://doi.org/10.21608/ijma.2021.58025.1243
[20] Jones MR, Urits I, Wolf J, Corrigan D, Colburn L, Peterson E, Williamson A, Viswanath O (2020) Drug-Induced Peripheral Neuropathy: A Narrative Review. Curr Clin Pharmacol. 15(1):38-48. https://doi.org/10.2174/1574884714666190121154813
[21] Clair C, Cohen MJ, Eichler F, Selby KJ, Rigotti NA (2015) The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis. J Gen Intern Med. 30(8):1193-203. https://doi.org/10.1007/s11606-015-3354-y
[22] Jende JME, Mooshage C, Kender Z, Kopf S, Groener JB, Heiland S, Juerchott A, Nawroth P, Bendszus M, Kurz FT (2022) Magnetic Resonance Neurography Reveals Smoking-associated Decrease in Sciatic Nerve Structural Integrity in Type 2 Diabetes. Front Neurosci. 15:811085. https://doi.org/10.3389/fnins.2021.811085
[23] Castelli G, Desai KM, Cantone RE (2020) Peripheral Neuropathy: Evaluation and Differential Diagnosis. Am Fam Physician. 102(12):732–739.
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