47 results on '"End stage renal disease"'
Search Results
2. Elbow Pain Related with Vascular Access Area: An Important but Frequently Overlooked Risk Factor for Upper Extremity Disability in Patients with End Stage Renal Disease.
- Author
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Çiftçi, Betül
- Subjects
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ELBOW pain , *BECK Depression Inventory , *CHRONIC kidney failure , *HEMODIALYSIS , *NEUROLOGICAL disorders , *FORELIMB , *MUSCULOSKELETAL pain , *MENTAL depression , *VISUAL analog scale - Abstract
Objective: This study aimed to assess the presence of elbow pain and its relationship with vascular access site for hemodialysis in end-stage renal disease patients. Methods: One-hundred and nine chronic end-stage renal disease patients over 18 years of age undergoing hemodialysis treatment were enrolled in the study. Patients who had undergone surgery of the upper extremity in the last three months and patients with cancer, chronic hearing loss, or neurologic diseases were excluded. Sociodemographic features were evaluated. The Beck Depression Inventory, the Nottingham Health Profile, the Disabilities of the Arm, Shoulder and Hand Score, and the Visual Analogue Scale were administered to all patients. Results: One-hundred and nine patients (38 women, 71 men) participated in the study. The mean age of the patients was 62.22 ± 11.64. The patients were grouped based on the presence of elbow pain into Group 1 (elbow pain positive, n=30) and Group 2 (elbow pain negative, n=79). There was a statistically significant difference between the groups in terms of vascular access site and elbow pain site (p=0.002). In addition, the patients with elbow pain were mostly women, and this result was statistically significant (p<0.05). Conclusions: According to the results of this study, there may be a relationship between elbow pain and hemodialysis vascular site. [ABSTRACT FROM AUTHOR]
- Published
- 2022
3. Management of Cutaneous Calciphylaxis.
- Author
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Kodumudi, Vijay, Jeha, George M., Mydlo, Nicholas, and Kaye, Alan D.
- Abstract
Calciphylaxis is a deadly, painful disease with a 1-year mortality of up to 50%. The disease is commonly associated with patients with end-stage kidney disease (ESKD), but it can manifest in non-uremic patients as well. In patients who are undergoing dialysis, the incidence of calciphylaxis can range from 0.04% to 4%. The progressive arterial calcification seen in calciphylaxis can affect multiple body organs, including the skin, brain, lungs, and muscle. In cutaneous calciphylaxis, painful and non-healing nodules, plaques, and ulcers may appear, increasing morbidity for patients. Diagnosis can be difficult, and the condition can clinically appear similar to other dermatological diseases, especially in non-uremic patients. Currently, skin biopsy with histological analysis is the most reliable method to help diagnose the condition. In certain cases, the use of medical imaging may be helpful. Treatment of pain in this condition can be difficult and should be multimodal and include wound care as well as modification of risk factors. Analgesic options include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), as well as analgesic options that are targeted for specific patients. There are currently multiple clinical trials underway that are studying targeted therapies for this condition. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
4. Pain, Sexual Dysfunction, and Depression in Hemodialysis Patients (SMILE)
- Author
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Dialysis Clinic, Inc., Liberty Dialysis, LLC, and DaVita Dialysis
- Published
- 2015
5. Approaches to Medication Management in Patients with Kidney Failure Opting for Conservative Management.
- Author
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Cho, Katherine H., Ashjian, Emily J., Smith, Michael, and Barton Pai, Amy
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ANEMIA treatment , *THERAPEUTIC use of iron , *BLOOD transfusion , *CHRONIC kidney failure , *MENTAL depression , *DRUG interactions , *DRUG side effects , *DYSPNEA , *FATIGUE (Physiology) , *HEMATOPOIETIC agents , *INSOMNIA , *IRON , *ITCHING , *MEDICAL care costs , *PAIN , *PALLIATIVE treatment , *KIDNEY failure , *SLEEP disorders , *THERAPEUTICS , *RESTLESS legs syndrome , *COMORBIDITY , *CONTINUING education units , *MEDICATION therapy management , *PATIENT decision making , *SYMPTOMS - Abstract
After consideration of risks and benefits, some patients with kidney failure choose conservative management. Conservative management of kidney failure (CM-KF) does not include dialysis or transplant and utilizes primarily pharmacologic strategies for symptom management, which can be challenging due to the number and complexity of symptoms. Additionally, there are safety concerns regarding altered pharmacokinetics and the adverse effects induced by some of the therapies that may be selected to treat symptoms. This review describes common kidney failure symptoms and provides recommendations for pharmacologic management in CM-KF. Selection of medication should be individualized to the patient and comorbidities, drug interactions, cost, and adverse effects should be carefully considered. Additional studies specifically focused on CM-KF are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
6. Non-uremic calciphylaxis in a woman without end-stage renal disease
- Author
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Gurleen Kaur, Meghan S. Hodson, George Lin, and Andrew Coates
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Biopsy ,Pain ,Case Report ,Disease ,030105 genetics & heredity ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Calciphylaxis ,medicine.diagnostic_test ,Vascular disease ,business.industry ,Renal medicine ,General Medicine ,medicine.disease ,Surgery ,Kidney Failure, Chronic ,Female ,business ,Hospital stay ,030217 neurology & neurosurgery - Abstract
A woman in her 60s with a history of lower extremity vascular disease presented with extreme pain and wounds in her legs which had kept her from walking for several weeks. The patient’s pain became intolerable throughout her hospital stay despite multiple surgical revascularisations. Biopsy of the patient’s calf wounds revealed evidence of calciphylaxis, a diagnosis which corresponds with this patient’s extreme pain. Our patient had no history of end-stage renal disease.
- Published
- 2023
7. Issues in Palliative Care: Pain Management for Adults with End Stage Renal Disease.
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Hain, Debra, Suragarn, Usar, and Bejar, Carlos
- Subjects
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TREATMENT of chronic kidney failure , *THERAPEUTIC use of narcotics , *ALTERNATIVE medicine , *HEALTH services accessibility , *HEMODIALYSIS , *HEMODIALYSIS facilities , *PAIN , *PALLIATIVE treatment , *PAIN management , *PAIN measurement , *CONTINUING education units , *ADULTS - Abstract
The article discusses pain management in the older adult population with end-stage renal disease (ESRD) receiving in-center hemodialysis. Topics covered include definition of palliative care by the World Health Organization, reasons for pain in older adults with ESRD receiving hemodialysis, and barriers to effective pain management.
- Published
- 2019
8. Management of pain in end‐stage renal disease patients: Short review.
- Author
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Raina, Rupesh, Krishnappa, Vinod, and Gupta, Mona
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PAIN management , *CHRONIC kidney failure , *QUALITY of life - Abstract
Abstract: Pain management in end stage renal disease (ESRD) patients is a complex and challenging task to accomplish, and effective pain and symptom control improves quality of life. Pain is prevalent in more than 50% of hemodialysis patients and up to 75% of these patients are treated ineffectively due to its poor recognition by providers. A good history for PQRST factors and intensity assessment using visual analog scale are the initial steps in the management of pain followed by involvement of palliative care, patient and family counseling, discussion of treatment options, and correction of reversible causes. First line should be conservative management such as exercise, massage, heat/cold therapy, acupuncture, meditation, distraction, music therapy, and cognitive behavioral therapy. Analgesics are introduced according to WHO guidelines (by the mouth, by the clock, by the ladder, for the individual, and attention to detail) using three‐step analgesic ladder model. Neuropathic pain can be controlled by gabapentin and pregabalin. Substitution/addition of opioid analgesics are indicated if pain control is not optimal. Commonly used opioids in ESRD patients are tramadol, oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Methadone, fentanyl, and buprenorphine are the ideal analgesics in ESRD. However, complex pain syndrome requires multidrug analgesic regimen comprising opioids, non‐opioids, and adjuvant medication, which should be individualized to the patient to achieve adequate pain control. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
9. Wellens Syndrome or Inverted U Waves: A Serious Clinical Condition Needing Immediate Attention Regardless of Symptoms
- Author
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Yeo Lee, Mohammad Reza Habibzadeh, and Mohammad Reza Movahed
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medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Wellens' syndrome ,Pain ,030204 cardiovascular system & hematology ,Coronary Angiography ,Chest pain ,Asymptomatic ,End stage renal disease ,Diabetes Complications ,Coronary artery disease ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,Diabetes Mellitus ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Coronary Artery Bypass ,Aged ,Cardiac catheterization ,business.industry ,Coronary Stenosis ,General Medicine ,medicine.disease ,Jaw ,Hypertension ,Cardiology ,Kidney Failure, Chronic ,Female ,Hypotension ,medicine.symptom ,business - Abstract
Abstrect Presentation : 76-year-old female with hypertension, diabetes, and end stage renal disease on hemodialysis was sent to the emergency department for complaining of neck and jaw pain associated with hypotension during dialysis. Her electrocardiogram is shown in figure 1. Clearly, biphasic T waves can be seen in V2-V3. These T wave changes were not seen in her last EKG. (figure 2). She was asymptomatic in the emergency department and her troponins were negative. Her electrolytes were also within normal limits with normal vital signs. Her cardiovascular exam was unremarkable. Assessment : The patient remained asymptomatic in the emergency room with persistent negative troponins. However, the appearance of pericardial biphasic T waves in V2 and V3 seen on her presenting EKG was consistent with Type A Wellen's syndrome EKG (or initially described by Dr. Gerson as inverted U waves). Even though, she had no chest pain and was hemodynamically stable, the classic appearance of Wellen's syndrome EKG is of major concern needing immediate diagnosis and treatment. Diagnosis : Patients presenting with Wellen's syndrome EKGs are at a very high risk for anterior myocardial infarction requiring an invasive work up regardless of their hemodynamic stability or level of cardiac enzymes. They have usually high-grade proximal left anterior descending or left main coronary artery disease. Management : As she was at a very high risk for myocardial infarction based on her EKG, she was taken to the cardiac catheterization laboratory despite remaining asymptomatic in the emergency department and having normal cardiac enzymes. Her coronary angiogram showed severe three vessel coronary artery disease with involvement of her proximal left anterior descending artery as suspected (figure 3). She underwent successful coronary artery bypass grafting. After her surgery, she did well and did not experience any further episodes of hypotension or jaw pain during her dialysis.
- Published
- 2021
10. Management of Cutaneous Calciphylaxis
- Author
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Vijay Kodumudi, Nicholas Mydlo, George M. Jeha, and Alan D. Kaye
- Subjects
030213 general clinical medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Pain ,Review ,Disease ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Calcific uremic arteriolopathy ,Renal Dialysis ,Risk Factors ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Dialysis ,Skin ,Calciphylaxis ,medicine.diagnostic_test ,business.industry ,Disease Management ,food and beverages ,General Medicine ,medicine.disease ,Dermatology ,Rheumatology ,Clinical trial ,030220 oncology & carcinogenesis ,Skin biopsy ,Disease Progression ,Kidney Failure, Chronic ,Cutaneous calciphylaxis ,Analgesia ,business ,Wound management ,Kidney disease - Abstract
Calciphylaxis is a deadly, painful disease with a 1-year mortality of up to 50%. The disease is commonly associated with patients with end-stage kidney disease (ESKD), but it can manifest in non-uremic patients as well. In patients who are undergoing dialysis, the incidence of calciphylaxis can range from 0.04% to 4%. The progressive arterial calcification seen in calciphylaxis can affect multiple body organs, including the skin, brain, lungs, and muscle. In cutaneous calciphylaxis, painful and non-healing nodules, plaques, and ulcers may appear, increasing morbidity for patients. Diagnosis can be difficult, and the condition can clinically appear similar to other dermatological diseases, especially in non-uremic patients. Currently, skin biopsy with histological analysis is the most reliable method to help diagnose the condition. In certain cases, the use of medical imaging may be helpful. Treatment of pain in this condition can be difficult and should be multimodal and include wound care as well as modification of risk factors. Analgesic options include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), as well as analgesic options that are targeted for specific patients. There are currently multiple clinical trials underway that are studying targeted therapies for this condition.
- Published
- 2020
11. Itch and Ache on Dialysis: New Approaches to Manage Uremic Pruritus and Restless Legs
- Author
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Soraya Arzhan, Mark Unruh, and Maria-Eleni Roumelioti
- Subjects
medicine.medical_specialty ,Uremic pruritus ,medicine.medical_treatment ,030232 urology & nephrology ,Pain ,Disease ,030204 cardiovascular system & hematology ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Renal Dialysis ,Restless Legs Syndrome ,medicine ,Humans ,Pain Management ,Restless legs syndrome ,Intensive care medicine ,Dialysis ,business.industry ,Pruritus ,Mortality rate ,Hematology ,General Medicine ,medicine.disease ,Nephrology ,Chronic dialysis ,Quality of Life ,Kidney Failure, Chronic ,business - Abstract
Background: Uremic pruritus (UP) and restless legs syndrome (RLS) are highly prevalent complaints among patients with end-stage renal disease (ESRD) undergoing chronic dialysis. These chronic troublesome symptoms lead to a significant decrease in quality of life (QOL) and increase in mortality rate. Despite their distressing characteristics, these symptoms usually remain under-recognized by healthcare providers. Therefore, careful history intake, and stepwise treatment are essential. Numerous pharmacological and non-pharmacological treatments have been demonstrated to help in controlling these 2 conditions. Summary: In this review, we discuss the latest findings regarding UP and RLS among ESRD patients on maintenance dialysis. We also examine different treatment options in this group of patients. The majority of these patients do not have the opportunity to receive a kidney transplant and need other treatments for these burdensome symptoms in order to improve their QOL and prognosis. Key Messages: UP and RLS are common but underdiagnosed conditions in ESRD patients on maintenance dialysis that are related to a decline in patients’ QOL and poor prognosis. The pathophysiology of these conditions remains not well understood. Therefore, controversies still exist on treatment options. Treating these conditions provides an opportunity to improve the health-related QOL and outcomes of dialysis patients.
- Published
- 2019
12. The impact of pain on the quality of life of patients with end-stage renal disease undergoing hemodialysis: a multicenter cross-sectional study from Palestine
- Author
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Aseel F. Samoudi, Sa’ed H. Zyoud, Samah W. Al-Jabi, Maha K. Marzouq, and Ahmad M. Samara
- Subjects
Adult ,Male ,Quality of life ,Palestine ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Population ,030232 urology & nephrology ,Pain ,Comorbidity ,lcsh:Computer applications to medicine. Medical informatics ,End stage renal disease ,End-stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Renal replacement therapy ,Brief Pain Inventory ,education ,Aged ,Pain Measurement ,education.field_of_study ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,General Medicine ,Middle Aged ,medicine.disease ,Transplantation ,Cross-Sectional Studies ,Hemodialysis ,Kidney Failure, Chronic ,lcsh:R858-859.7 ,Female ,business ,Kidney disease - Abstract
Background Chronic kidney disease is considered as a global health problem. Hemodialysis (HD), following renal transplantation, is the most common form of renal replacement therapy. However, HD may impact the quality of life (QOL). Pain is a frequent complaint among this population that also affects their QOL. The purposes of this study were to assess pain and QOL among end-stage renal disease (ESRD) patients on HD and to examine their association. Methods This was a multicenter, cross-sectional study that occurred in Palestine between August and November 2018. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QOL, respectively. Results A total of 300 participants were included in the final study. The average age of the subjects was 54 ± 16 years. Their median EQ-5D score was 0.68 [0.54–0.88], whereas their median EQ-VAS score was 60 [40–75]. A statistically significant association of pain severity score with EQ-5D score was found (r = − 0.783, p p p p p p = 0.003), and those with lower pain interference scores (p Conclusions Pain has a significant negative impact on QOL in ESRD patients undergoing HD. The subgroups that were at higher risk included elderly patients, females, those with higher BMI, those without a formal education, those unemployed, those living with low monthly income, smokers, those who have multiple comorbidities, and patients with longer dialysis vintage. Our findings provide reliable data for educators and clinicians working with HD patients.
- Published
- 2021
13. Pain management in patients with end-stage renal disease and calciphylaxis- a survey of clinical practices among physicians
- Author
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Mary Miller, Smeeta Sinha, Aoife Lowney, and Rajkumar Chinnadurai
- Subjects
Advance care planning ,Nephrology ,medicine.medical_specialty ,Palliative care ,Referral ,Amitriptyline ,Pregabalin ,030232 urology & nephrology ,Pain ,Disease ,Pain, Procedural ,Guidelines ,lcsh:RC870-923 ,End stage renal disease ,Advance Care Planning ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Practice Patterns, Physicians' ,Palliative Medicine ,Survey ,Intensive care medicine ,Referral and Consultation ,Acetaminophen ,Analgesics ,Calciphylaxis ,business.industry ,Breakthrough Pain ,Guideline ,Analgesics, Non-Narcotic ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,United Kingdom ,Pain management ,Analgesics, Opioid ,Opioids ,Kidney Failure, Chronic ,Gabapentin ,business ,Research Article - Abstract
Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline. Methods An online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. Results One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time. Conclusion There was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.
- Published
- 2020
14. Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients
- Author
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Mark S. Segal, Rajesh Mohandas, Sanjeev Kumar, Rupam Ruchi, Tezcan Ozrazgat-Baslanti, Shahab Bozorgmehri, and Ashutosh M Shukla
- Subjects
Male ,medicine.medical_specialty ,Article Subject ,Population ,030232 urology & nephrology ,Pain ,End stage renal disease ,Fentanyl ,03 medical and health sciences ,Benzodiazepines ,0302 clinical medicine ,Internal medicine ,medicine ,Odds Ratio ,Humans ,030212 general & internal medicine ,education ,Retrospective Studies ,education.field_of_study ,lcsh:R5-920 ,business.industry ,Opioid overdose ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,3. Good health ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Neurology ,Opioid ,Hydrocodone ,Kidney Failure, Chronic ,Female ,Drug Overdose ,business ,lcsh:Medicine (General) ,Methadone ,medicine.drug ,Research Article - Abstract
Background. Opioid use is common in end-stage renal disease (ESRD) patients. However, safety of individual opioids and concomitant benzodiazepine use has not been studied. Objective. To study the epidemiology of opioid and concomitant benzodiazepine use in ESRD population. To study the clinical safety profile of individual opioids in patients on hemodialysis. Design. Retrospective analysis of the U.S. Renal Data System. A comprehensive review of the current literature was performed to update currently used opioid safety classification. Participants. ESRD patients ≥18 years on hemodialysis who were enrolled in Medicare A and B and Part D between 2006 and 2012, excluding those with malignancy. Main Measures. Hospital admission with diagnosis of prescription opioid overdose within 30, 60, and 90 days of prescription; death due to opioid overdose. Results. Annually, the percentage of patients prescribed any opioid was 52.2%. Overall trend has been increasing except for a small dip in 2011, despite which the admissions due to opioid overdose have been rising. 30% of those who got a prescription for opioids also got a benzodiazepine prescription. 56.5% of these patients received both prescriptions within a week of each other. Benzodiazepine use increased the odds of being on opioids by 3.27 (CI 3.21–3.32) and increased the odds of hospitalization by 50%. Opioids considered safe such as fentanyl and methadone were associated with 3 and 6 folds higher odds of hospitalization within 30 days of prescription. Hydrocodone had the lowest odds ratio (1.9, CI 1.8–2.0). Conclusions. Concurrent benzodiazepine use is common and associated with higher risk of hospitalization due to opioid overdose. Possible opioid-associated hospital admission rate is 4-5 times bigger in ESRD population than general population. Current safety classification of opioids in these patients is misleading, and even drugs considered safe based on pharmacokinetic data are associated with moderate to very high risk of hospitalization. We propose a risk-stratified classification of opioids and suggest starting to use them in all ESRD patients.
- Published
- 2019
- Full Text
- View/download PDF
15. The Symptoms Prevalence, Medical Interventions, and Health Care Service Needs for Patients With End-Stage Renal Disease in a Renal Palliative Care Program
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David Sai-Ping Yong, Sze-Kit Yuen, Doris M.W. Tse, and Annie O. Kwok
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Palliative care ,030232 urology & nephrology ,Pain ,Anorexia ,Disease ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Cause of Death ,Edema ,Humans ,Pain Management ,Medicine ,Outpatient clinic ,030212 general & internal medicine ,Fatigue ,Aged ,Retrospective Studies ,Cause of death ,Aged, 80 and over ,Terminal Care ,business.industry ,Palliative Care ,Retrospective cohort study ,General Medicine ,Health Services ,Home Care Services ,Dyspnea ,Quality of Life ,Kidney Failure, Chronic ,Female ,medicine.symptom ,business - Abstract
A retrospective study was conducted to evaluate the symptoms prevalence and interventions initiated in the last 2 weeks of life, health care service utilization, and causes of death of patients with end-stage renal disease (ESRD under a renal palliative care (RPC) program. A total of 335 RPC patients were included, of which 226 patients died during the study period. The 5 most prevalent symptoms were dyspnea (63.7%), fatigue (51.8%), edema (48.2%), pain (44.2%), and anorexia (38.1%); and the 5 most prevalent interventions initiated were oxygen (69.5%), parenteral infusion (67.3%), antibiotics (53.5%), bladder catheterization (44.7%), and analgesic (39.8%) in the last 2 weeks of life. Each patient received 3.5 ± 4.4 outpatient clinic visit, 3.4 ± 10.3 home care visits, and 3.1 ± 2.7 hospital admissions. Besides ESRD (51.8%), the most common causes of death were cardiovascular events (18.6%) and infection (17.2%).
- Published
- 2016
16. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review
- Author
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Livia Puljak, Eliana Burilovic, and Tonci Brkovic
- Subjects
medicine.medical_specialty ,Population ,prevalence ,030232 urology & nephrology ,MEDLINE ,Medicine (miscellaneous) ,CINAHL ,Disease ,pain, hemodialysis, systematic review ,Review ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Epidemiology ,Medicine ,pain ,030212 general & internal medicine ,education ,Pharmacology, Toxicology and Pharmaceutics (miscellaneous) ,education.field_of_study ,hemodialysis ,business.industry ,Health Policy ,Chronic pain ,medicine.disease ,Patient Preference and Adherence ,Physical therapy ,epidemiology ,business ,intensity ,Social Sciences (miscellaneous) - Abstract
Tonci Brkovic,1 Eliana Burilovic,2 Livia Puljak3 1Department of Internal Medicine, Division of Nephrology, 2Department of Psychiatry, University Hospital Split, 3Department of Anatomy, Histology and Embryology, Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Objectives: Understanding the epidemiology of pain in patients on hemodialysis (HD) is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. Materials and methods: We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool.Results: We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain.Conclusion: The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients’ quality of life and pain-related disability. Keywords: pain, hemodialysis, prevalence, intensity, epidemiology
- Published
- 2016
17. Understanding What Influences the Health-Related Quality of Life of Hemodialysis Patients: A Collaborative Study in England and Ireland
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Marie Murphy, Tony O'Brien, Katherine Bristowe, William D. Plant, Catherine Vinen, Liam F. Casserly, Eanna L Lowney, Peter J. Conlon, Regina McQuillan, Aoife C. Lowney, F.E. Murtagh, Joseph A. Eustace, Helena T Myles, and Katie Shepherd
- Subjects
Male ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,Population ,Pain ,Context (language use) ,Severity of Illness Index ,End stage renal disease ,Cost of Illness ,Quality of life ,Renal Dialysis ,Pain assessment ,medicine ,Humans ,education ,General Nursing ,Aged ,Psychological Tests ,education.field_of_study ,business.industry ,Palliative Care ,Middle Aged ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,England ,Cohort ,Quality of Life ,Physical therapy ,Kidney Failure, Chronic ,Regression Analysis ,Female ,Neurology (clinical) ,Hemodialysis ,business ,Ireland - Abstract
Context The international cohort of hemodialysis patients is aging and increasing in number. Nephrologists have a therapeutic relationship with their patients that may span decades. Often overlooked components of chronic disease management include symptom control and assessment of health-related quality of life (HRQoL). Objectives This study describes the symptom profile of a large cohort of patients with end-stage renal disease on hemodialysis in England and Ireland and evaluates how symptom burden and other factors influence quality-of-life scores. Methods A prospective cross-sectional observational study of hemodialysis patients was conducted in Ireland and England during 2011 and 2012. Two validated clinical tools were used to determine HRQoL and symptom burden. Demographic and clinical data were examined, and regression analysis was used to determine associations with HRQoL scores. Results A total of 893 patients on hemodialysis (mean [SD] age 64 [16] years) had a high symptom burden and poor HRQoL compared with population norms. Specifically, 64% of patients reported pain (95% confidence interval 61%–67%) and 79% reported weakness (95% confidence interval 75%–81%). A total of 43 percent of patients reported between six and 10 symptoms in the week preceding the survey. HRQoL was significantly and independently associated with poor mobility and pain and remained significant after adjusting for variations in clinical characteristics. Being listed on a transplant wait-list register was positively associated with HRQoL. Conclusion These findings illustrate the high symptom burden and poor HRQoL of the hemodialysis population. Emphasis during clinical reviews on pain assessment and on assessing mobility plus interventions, such as pain management and physiotherapy/occupational therapy, are practical ways for renal teams to help improve patients' quality of life.
- Published
- 2015
18. Management of Pain and Quality of Life in Patients with Chronic Kidney Disease Undergoing Hemodialysis
- Author
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Georgios I Panoutsopoulos, Victoria Alikari, Adamantia Aroni, Athanasios Sachlas, Sofia Zyga, Paraskevi Theofilou, and John Stathoulis
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pain ,Holistic health ,End stage renal disease ,Quality of life ,Renal Dialysis ,Surveys and Questionnaires ,medicine ,Humans ,Pain Management ,Medical history ,Advanced and Specialized Nursing ,Self-efficacy ,business.industry ,Middle Aged ,medicine.disease ,Comorbidity ,Self Efficacy ,Treatment Outcome ,Quality of Life ,Physical therapy ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business ,Kidney disease - Abstract
An important dimension that influences the quality of life of hemodialysis patients is the pain they experience. Quality of life and self-efficacy in pain can play an important role in chronic kidney disease and treatment outcomes. The purpose of the study was to examine self-efficacy in pain and quality of life among patients with end stage renal disease undergoing hemodialysis. Between April 2013 and June 2013, 224 hemodialysis patients completed the Missoula-VITAS Quality of Life Index-15 and the Pain Self-Efficacy Questionnaire. The study was conducted in four dialysis units in hospitals of the Peloponnese region. Sociodemographic data of patients and their individual medical history were recorded. Statistical analysis was performed using SPSS version 19. The more effective the self-efficacy in pain, the lower the quality of life enjoyed by hemodialysis patients. The majority of respondents described the overall quality of life as "moderate," while the self-efficacy in pain depended on comorbidity or complications that accompany the process of hemodialysis. The findings of this study can be used in the development and improvement of health services for the management of patients. Healthcare professionals should understand the concerns and treat the symptoms of patients that affect quality of life, providing thereby holistic health care.
- Published
- 2015
19. End-of-Life Experience of Older Adults Dying of End-Stage Renal Disease: a Comparison with Cancer
- Author
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Zhonghe Li, Melissa W. Wachterman, Edward R. Marcantonio, Nancy L. Keating, Stuart R. Lipsitz, and Karl A. Lorenz
- Subjects
Gerontology ,Advance care planning ,Male ,Pediatrics ,medicine.medical_specialty ,030232 urology & nephrology ,Pain ,Context (language use) ,Disease ,Article ,End stage renal disease ,Interviews as Topic ,03 medical and health sciences ,Advance Care Planning ,0302 clinical medicine ,Cost of Illness ,Neoplasms ,medicine ,Humans ,Family ,030212 general & internal medicine ,Longitudinal Studies ,Propensity Score ,General Nursing ,Aged ,Aged, 80 and over ,Terminal Care ,business.industry ,Mortality rate ,Health and Retirement Study ,Anesthesiology and Pain Medicine ,Logistic Models ,Socioeconomic Factors ,Propensity score matching ,Kidney Failure, Chronic ,Female ,Neurology (clinical) ,business ,End-of-life care - Abstract
Older adults with end-stage renal disease (ESRD) are a rapidly growing group of seriously ill patients. Yet, despite a mortality rate almost twice that of cancer, less is known about the impact of ESRD on patients' end-of-life experience.To compare the end-of-life experience of older adults who died of ESRD vs. cancer.We used data from the Health and Retirement Study, a nationally representative survey of older adults. Our sample included 1883 Health and Retirement Study participants who died of cancer or ESRD between 2000 and 2010 and their family respondents. We compared advance care planning, treatment intensity, and symptoms between the two groups and used propensity score weighting to adjust for differences by diagnosis.Among propensity-weighted cohorts, older adults with ESRD, compared with similar patients with cancer, were less likely to have end-of-life instructions (adjusted proportions 38.5% vs. 49.7%; P = 0.005) and were more likely to die in the hospital (53.5% vs. 29.0%; P 0.001) and to use the intensive care unit in the last two years of life (57.1% vs. 37.0%; P 0.001). Decedents with ESRD and cancer had similarly high rates of moderate or severe pain (53.7% vs. 57.8%; P = 0.34) and all other symptoms.Older adults dying of ESRD had lower rates of advance care planning and higher treatment intensity near the end of life than similar patients dying of cancer; both groups had similarly high rates of symptoms. Efforts are needed to make treatment more supportive and alleviate suffering for older adults with ESRD and their families near the end of life.
- Published
- 2017
20. Rare etiology of severe calf pain and induration in a child with end-stage renal disease: Answers
- Author
-
Eihab AlKhasawneh, Gurinder Kumar, Mohammed Khair AlGhabra, Baker Ayyash, Aman Preet Singh Sohal, and Nitin Airon
- Subjects
Nephrology ,medicine.medical_specialty ,business.industry ,General surgery ,030232 urology & nephrology ,Pain ,End stage renal disease ,Surgery ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Etiology ,Humans ,Kidney Failure, Chronic ,business ,Medical science ,Child - Published
- 2017
21. Quality of life of patients with end-stage renal disease in Guinea
- Author
-
Nestor Nankeu, Lionel Rostaing, Mohamed Lamine Kaba, Bah Kadiatou-Hadiatou Bah, Alpha Oumar Bah, and Mamadou Cellou Balde
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Younger age ,Health Status ,Pain ,Renal function ,lcsh:Medicine ,Comorbidity ,Disease ,End stage renal disease ,Cost of Illness ,Quality of life ,Pain control ,Risk Factors ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Social Behavior ,business.industry ,lcsh:R ,Age Factors ,General Medicine ,Middle Aged ,medicine.disease ,Mental health ,humanities ,Mental Health ,Treatment Outcome ,Health Care Surveys ,Quality of Life ,Physical therapy ,Kidney Failure, Chronic ,Female ,Guinea ,business - Abstract
This questionnaire-based study included 69 patients from the Republic of Guinea with end-stage renal disease (ESRD) and was conducted over 12 months. The factors that affected their quality of life (QoL) were determined. The included ESRD patients had an estimated creatinine clearance (CCr) of 4, P = 0.01). Good QoL was associated with younger age, fewer comorbidities, less severe physical pain, and fewer physical or social limitations. QoL could be increased by improving comorbidity treatments, giving more effective pain control, and providing more assistance for social and physical limitations.
- Published
- 2014
22. Pain in the Geriatric Patient with Advanced Chronic Disease
- Author
-
Prin Amorapanth, Eugenia L. Siegler, and Veerawat Phongtankuel
- Subjects
medicine.medical_specialty ,Pain ,Disease ,Comorbidity ,030204 cardiovascular system & hematology ,Global Health ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,medicine ,Prevalence ,Humans ,Pain Management ,030212 general & internal medicine ,Disease management (health) ,Intensive care medicine ,Stroke ,Aged ,Pain Measurement ,business.industry ,medicine.disease ,Geriatric patient ,Chronic disease ,Heart failure ,Chronic Disease ,Physical therapy ,Geriatrics and Gerontology ,business - Abstract
The World Health Organization, one of the leading authorities on pain management, stressed the need for further guidelines to help manage pain in patients with chronic disease. In light of the impact of pain on morbidity and quality of life, this article summarizes current knowledge about pain experienced by older adults in 3 advanced non-cancer-related chronic diseases (ie, congestive heart failure, end-stage renal disease, and stroke) in which pain is common but not typically a primary focus of disease management. This article examines the data on the prevalence of pain, co-occurring symptoms, and challenges in managing pain in these conditions.
- Published
- 2016
23. Long-Term Impact of Laparoscopic Cyst Decortication on Renal Function, Hypertension and Pain Control in Patients with Autosomal Dominant Polycystic Kidney Disease
- Author
-
Cathy Chen, Brent W. Miller, Timur M. Roytman, Alana Desai, Robert S. Figenshau, Brian M. Benway, Ralph V. Clayman, Youssef S. Tanagho, Melissa Millar, Sam B. Bhayani, and Mohammed Haseebuddin
- Subjects
Adult ,Male ,Nephrology ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Autosomal dominant polycystic kidney disease ,Pain ,Renal function ,Kidney Function Tests ,Nephrectomy ,End stage renal disease ,Young Adult ,Internal medicine ,medicine ,Polycystic kidney disease ,Humans ,Pain Management ,Dialysis ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,Polycystic Kidney, Autosomal Dominant ,medicine.disease ,Surgery ,Hypertension ,Female ,Laparoscopy ,business ,Kidney disease - Abstract
Cyst proliferation in patients with autosomal dominant polycystic kidney disease is associated with renal failure, hypertension and pain. We examined the long-term impact of laparoscopic cyst decortication on renal function, hypertension and pain control in patients with adult dominant polycystic kidney disease presenting with refractory pain.Between 1994 and 2003, 37 patients with adult dominant polycystic kidney disease underwent laparoscopic cyst decortication at Barnes-Jewish Hospital. A total of 19 patients (4 male, 15 female) with at least 3-year followup were included in the study. Renal function was evaluated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) estimated glomerular filtration rate formula. End stage renal disease was defined as progression to transplant, dialysis or stage 5 chronic kidney disease. Hypertension was evaluated using the antihypertensive therapeutic index. Pain assessment was based primarily on a telephone questionnaire.At a mean followup of 10.9 years (range 6.4 to 16.9), 67% of evaluable patients reported more than 50% improvement in pain. Ten patients had progression to end stage renal disease--3 dialysis, 6 transplant, and 1 chronic kidney disease stage 5. Two patients had stage 5 chronic kidney disease at initial presentation. A comparison of preoperative estimated glomerular filtration rate between patients with and those without end stage renal disease revealed a lower preoperative estimated glomerular filtration rate in the former group (43.4 vs 75.4 ml/minute/1.73 m(2), p = 0.01). Of the patients 53% had an improved or stable antihypertensive therapeutic index at last followup, although no improvement in mean overall antihypertensive therapeutic index was noted (4.7 pre-laparoscopic cyst decortications vs 7.0 post-laparoscopic cyst decortications, p = 0.28).Durable pain relief but not hypertension control was seen at 10-year followup. Preoperative estimated glomerular filtration rate is a strong predictor of post-laparoscopic cyst decortication progression to end stage renal disease. A cautious approach with laparoscopic cyst decortication should be taken in patients with poor preoperative renal function.
- Published
- 2012
24. Is There a Legitimate Role for the Therapeutic Use of Cannabinoids for Symptom Management in Chronic Kidney Disease?
- Author
-
Sara N. Davison and Joseph S. Davison
- Subjects
medicine.medical_specialty ,Nausea ,Pain ,Context (language use) ,urologic and male genital diseases ,End stage renal disease ,Quality of life (healthcare) ,Cannabinoid Receptor Modulators ,medicine ,Humans ,Receptors, Cannabinoid ,Adverse effect ,Intensive care medicine ,General Nursing ,Cannabis ,Analgesics ,biology ,Cannabinoids ,business.industry ,Chronic pain ,biology.organism_classification ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,Anesthesiology and Pain Medicine ,Quality of Life ,Kidney Failure, Chronic ,Neurology (clinical) ,medicine.symptom ,business ,Kidney disease - Abstract
Chronic pain is a common and debilitating symptom experienced in the context of numerous other physical and emotional symptoms by many patients with chronic kidney disease (CKD). Management of pain with opioids in CKD can be problematic given the prominence of adverse effects of opioids in CKD, which may exacerbate symptoms, such as nausea, anorexia, pruritus, and insomnia, all of which impact negatively on patients' health-related quality of life. Novel therapeutic approaches for pain and symptom management in CKD are required. Recent research in the area of cannabinoids (CBs) is legitimizing the use of cannabis-based medicine. In this review, we describe the symptom burden borne by patients with CKD and review some of the key basic science and clinical literature to evaluate the potential use of CBs for the management of overall symptom burden in CKD.
- Published
- 2011
25. The Prevalence and Management of Chronic Pain in End-Stage Renal Disease
- Author
-
Sara N. Davison
- Subjects
Nephrology ,medicine.medical_specialty ,Health Status ,MEDLINE ,Pain ,Disease ,urologic and male genital diseases ,Alberta ,End stage renal disease ,Quality of life (healthcare) ,Pain assessment ,Internal medicine ,Epidemiology ,medicine ,Humans ,Intensive care medicine ,General Nursing ,Chronic Kidney Disease-Mineral and Bone Disorder ,business.industry ,Calciphylaxis ,Chronic pain ,Amyloidosis ,General Medicine ,Middle Aged ,medicine.disease ,Fibrosis ,female genital diseases and pregnancy complications ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Chronic Disease ,Quality of Life ,Kidney Failure, Chronic ,business - Abstract
A growing body of literature has demonstrated that chronic pain is common for patients with end- stage renal disease (ESRD), is typically moderate or severe, and impacts virtually every aspect of health-related quality of life. Unfortunately, there is a lack of clinical and research focus in this area in nephrology and pain in ESRD is undertreated. This paper reviews the epidemiology of chronic pain in ESRD, discusses basic principles of pain assessment and management, and highlights some of the challenges in pain management in ESRD with the hope of guiding health professionals in the effective management of pain in patients with ESRD.
- Published
- 2007
26. An Approach to Pain Management in End Stage Renal Disease: Considerations for General Management and Intradialytic Symptoms
- Author
-
Sara N. Davison, Frank Brennan, Holly M. Koncicki, and Katie Vinen
- Subjects
medicine.medical_specialty ,Population ,MEDLINE ,Pain ,End stage renal disease ,Quality of life (healthcare) ,Renal Dialysis ,medicine ,Prevalence ,Humans ,Pain Management ,Intensive care medicine ,education ,education.field_of_study ,business.industry ,Generalized pain ,medicine.disease ,Nephrology ,Physical therapy ,Kidney Failure, Chronic ,Neuralgia ,medicine.symptom ,Headaches ,business ,Muscle cramp ,Kidney disease - Abstract
The prevalence and severity of symptoms in patients with advanced chronic kidney disease is higher than those of the general population and comparable to those with other chronic and serious medical conditions. Despite the prevalence and severity in this population, symptoms continue to be under-recognized and inadequately managed. The recognition of specific intradialytic pain syndromes such as pain related to arteriovenous access, headaches, muscle cramps or generalized pain by providers may aid in improving patient compliance and quality of life. The approach to pain management in end stage renal disease patients follows that of the general population with specific considerations regarding clearance and potential side effects guiding selection of agents. Overall, evidence is limited regarding the pharmacology of many medications in this population.
- Published
- 2015
27. SYMPTOM MANAGEMENT IN PATIENTS WITH ESTABLISHED RENAL FAILURE MANAGED WITHOUT DIALYSIS
- Author
-
Julia Addington-Hall, Irene J Higginson, Paul H. Donohoe, and Fliss E M Murtagh
- Subjects
Sleep Wake Disorders ,medicine.medical_specialty ,medicine.medical_treatment ,Pain ,Disease ,Anxiety ,Drug Administration Schedule ,End stage renal disease ,Renal Dialysis ,Restless Legs Syndrome ,medicine ,Humans ,Cooperative Behavior ,Intensive care medicine ,Fatigue ,Nursing Assessment ,Dialysis ,Patient Care Team ,Analgesics ,Health Services Needs and Demand ,Depression ,business.industry ,Pruritus ,Palliative Care ,Nausea ,Hydromorphone ,medicine.disease ,Anorexia ,Dyspnea ,Nephrology ,Practice Guidelines as Topic ,Kidney Failure, Chronic ,business ,Constipation ,Oxycodone ,Buprenorphine ,medicine.drug ,Kidney disease ,Methadone - Abstract
Increasing numbers of patients with chronic kidney disease Stage 5 (GFR
- Published
- 2006
28. Calciphylaxis in pediatric end-stage renal disease
- Author
-
Rudolph P. Valentini, Tej K. Mattoo, Abubakr A. Imam, David A. Bloom, and Gaurav Kapur
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,Adolescent ,Biopsy ,medicine.medical_treatment ,Pain ,Sevelamer ,Peritoneal dialysis ,End stage renal disease ,Fatal Outcome ,Internal medicine ,medicine ,Humans ,Muscle, Skeletal ,Skin ,Calciphylaxis ,Muscle biopsy ,medicine.diagnostic_test ,business.industry ,Phosphorus ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Parathyroid Hormone ,Pediatrics, Perinatology and Child Health ,Kidney Failure, Chronic ,Calcium ,business ,Peritoneal Dialysis ,medicine.drug ,Calcification - Abstract
Calciphylaxis is a rare, but life-threatening complication of end-stage renal disease (ESRD) that has been reported mostly in adult patients. The exact etiology is unknown, but the disease is commonly associated with a high calcium-phosphorus product and elevated levels of parathyroid hormone (PTH). We herein review the published reports on calciphylaxis in ESRD patients less than 18 years old and report the case of a patient with severe calciphylaxis who presented with lower extremity pain, muscle tenderness and difficulty in walking. The serum PTH was low, and the calcium-phosphorus product was normal. The diagnosis of calciphylaxis was confirmed by a muscle biopsy. Treatment with low calcium peritoneal dialysate and substitution of calcium-based phosphorus binders with sevelamer (Renagel) was unsuccessful. The patient's clinical condition progressed to extensive soft tissue calcification and ulcerating skin lesions. Nine months after the onset of symptoms, the patient died of cardiopulmonary arrest.
- Published
- 2005
29. Chronic Pain in End-Stage Renal Disease
- Author
-
Sara N. Davison
- Subjects
Nephrology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Chronic pain ,Pain ,Disease ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,End stage renal disease ,Analgesics, Opioid ,Quality of life (healthcare) ,Pain assessment ,Internal medicine ,Chronic Disease ,Epidemiology ,medicine ,Humans ,Kidney Failure, Chronic ,Hemodialysis ,Intensive care medicine ,business ,Pain Measurement - Abstract
A growing body of literature has shown that chronic pain is common for patients with end-stage renal disease (ESRD), is typically moderate or severe, and impacts virtually every aspect of health-related quality of life. Unfortunately, there is a lack of clinical and research focus in this area in nephrology, and pain in ESRD is undertreated. This article will review the epidemiology of chronic pain in ESRD, discuss basic principles of pain assessment and management, and highlight some of the challenges in pain management in ESRD with the hope of guiding health professionals in the effective management of pain in patients with ESRD.
- Published
- 2005
30. Factors associated with coping mechanisms among Egyptian patients with end stage renal disease and on haemodialysis
- Author
-
Mona Ahmed Abdel Mawgoud and Hussein H. Soliman
- Subjects
Adult ,Male ,Religion and Psychology ,medicine.medical_specialty ,Coping (psychology) ,media_common.quotation_subject ,Pain ,Personal Satisfaction ,End stage renal disease ,Renal Dialysis ,Health care ,Adaptation, Psychological ,Medicine ,Humans ,Psychiatry ,General Psychology ,media_common ,Variables ,Medical treatment ,business.industry ,Social Support ,Regression analysis ,Middle Aged ,Kidney Failure, Chronic ,Regression Analysis ,Egypt ,Female ,business ,Attitude to Health ,Clinical psychology - Abstract
This study intends to identify factors that influence coping with physical and emotional impacts of haemodialysis on patients in Egypt. A questionnaire was administrated to a random sample of 162 participants, 87 men and 75 women, who had received outpatient treatment in health care clinics in seven Egyptian cities. A regression model was used with four independent variables (view of medical treatment, effect of pain, adjustment to treatment, and satisfaction with life) to explain variance in satisfaction with self and coping. Results show about half the variance in the patients' ability to cope and express satisfaction with the self was explained by the independent variables ( R2=–.55, R2=.45). Implications contributing to adjustment and coping are presented, showing the need to advance medical service and enhance patients' ability to develop effective strategies.
- Published
- 2014
31. Painful myopathy and end-stage renal disease
- Author
-
Vivette D. D'Agati, Glen S. Markowitz, Xiaolin Liu-Jarin, Peter E. Fisher, Gill L. Frei, and Cheryl L. Kunis
- Subjects
Adult ,medicine.medical_specialty ,Henoch-Schonlein purpura ,IgA Vasculitis ,medicine.medical_treatment ,Pain ,Kidney ,End stage renal disease ,Fatal Outcome ,Muscular Diseases ,Renal Dialysis ,medicine ,Humans ,Renal osteodystrophy ,Myopathy ,Calciphylaxis ,Vascular disease ,business.industry ,Muscles ,Calcinosis ,medicine.disease ,Kidney Transplantation ,Surgery ,Nephrology ,Kidney Failure, Chronic ,Female ,Hemodialysis ,Atrophy ,medicine.symptom ,business ,Kidney disease - Published
- 2001
32. The haemodialysis machine as a lifeline: experiences of suffering from end-stage renal disease
- Author
-
Birger Hagren, Elisabeth Severinsson, Kim Lützén, Naomi Clyne, and Inga-Märta Pettersen
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Pain ,Nursing Methodology Research ,Disease ,urologic and male genital diseases ,End stage renal disease ,Life Change Events ,Quality of life ,Renal Dialysis ,Surveys and Questionnaires ,Activities of Daily Living ,Adaptation, Psychological ,medicine ,Humans ,Intensive care medicine ,General Nursing ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,Quality of Life ,Kidney Failure, Chronic ,Pain psychology ,Female ,Haemodialysis machine ,business ,Attitude to Health ,Needs Assessment ,Stress, Psychological - Abstract
The aim of this study was to describe patients' experiences of suffering from end-stage renal disease (ESRD).The rationale was to investigate how persons find meaning or make sense of their situation and how they experience suffering. The theoretical basis for the study was to view suffering at three levels. The first level was related to sickness and treatment. The second level was related to the care provided and the third level was related to each person's unique life experience and existence.Data were collected by interviews focusing on questions concerning daily life, needs, and expectations for the future. A qualitative interpretative content analysis was used. Fifteen patients between the ages of 50-86 participated in the study.Two main themes were identified describing these patients suffering. The first theme, 'the haemodialysis machine as a lifeline' consisted of three subthemes: 'loss of freedom', 'dependence on the caregiver', and 'disrupted marital, family and social life'. The second theme 'alleviation of suffering' consisted of two subthemes: 'gaining a sense of existential optimism' and 'achieving a sense of personal autonomy'.This study indicated that, in the lives of patients on haemodialysis, the main areas of suffering were related to loss of freedom expressed as dependence on the haemodialysis machine as a lifeline and, the caregivers. This time-consuming and tiring dependence affected marital, family and social life. Alleviation of suffering could be achieved by accepting dependence on the haemodialysis machine and maintaining autonomy by being seen as an individual by the caregivers.
- Published
- 2001
33. Laparoscopic nephrectomy in patients with end-stage renal disease and autosomal dominant polycystic kidney disease
- Author
-
Marcos Rothstein, Arieh L. Shalhav, Matthew D. Dunn, Ralph V. Clayman, Andrew J. Portis, Abdelhamid M. Elbahnasy, and Elspeth M. McDougall
- Subjects
Male ,medicine.medical_specialty ,media_common.quotation_subject ,medicine.medical_treatment ,Autosomal dominant polycystic kidney disease ,Pain ,Nephrectomy ,End stage renal disease ,Postoperative Complications ,Renal Dialysis ,Humans ,Medicine ,Kidney transplantation ,Aged ,Hematuria ,media_common ,business.industry ,Convalescence ,Length of Stay ,Middle Aged ,Polycystic Kidney, Autosomal Dominant ,medicine.disease ,Kidney Transplantation ,Abdominal mass ,Surgery ,Nephrology ,Hypertension ,Urinary Tract Infections ,Kidney Failure, Chronic ,Female ,Laparoscopy ,Intractable pain ,medicine.symptom ,business ,Follow-Up Studies ,Kidney disease - Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is often characterized by end-stage renal disease (ESRD) and problems including pain, hematuria, and infection. Open nephrectomy is curative; however, the morbidity of the procedure is considerable. Between 1995 and 1998, 11 laparoscopic nephrectomies were performed on nine symptomatic patients (five men and four women) with ESRD and ADPKD. Two patients underwent a staged bilateral laparoscopic nephrectomy. All patients presented with abdominal or flank pain and an abdominal mass. Other clinical problems included hypertension in eight patients, urinary tract infections in two patients, and gross hematuria in one patient. Seven patients were receiving long-term dialysis treatment, and two patients had undergone prior renal transplantation. Patients were evaluated for preoperative and postoperative pain, analgesic use, hospital course, and convalescence. The overall average operative time was 6.3 hours, with an average estimated blood loss of 153 mL. Eight nephrectomy specimens were removed by morcellation, and three specimens were removed intact through a 7- to 12-cm incision. The average hospital stay was 3 days, and the average time to normal activity was 5 weeks. With a mean follow-up of 31 months, all nine patients reported elimination of their preoperative pain based on a pain analogue score. Six major and two minor complications occurred, including blood transfusion, a vena cavotomy, splenic cyanosis, pulmonary embolism, clotted arteriovenous fistula, and brachial plexus injury. Incisional hernias occurred in two of the three patients who underwent open removal. One patient noted improvement, and two patients noted resolution of their hypertension postoperatively. Laparoscopic nephrectomy in patients with ADPKD and ESRD offers an effective alternative to open nephrectomy to manage renal-related pain. This procedure provides the benefits of minimal intraoperative blood loss, minimal postoperative pain, brief hospital stay, and rapid convalescence.
- Published
- 2000
34. Neglected rupture of the quadriceps tendon in a patient with chronic renal failure (case report and review of the literature)
- Author
-
Moustapha Mahfoud, Zouhir Ameziane Hassani, Moradh Elyaacoubi, and Moncef Boufettal
- Subjects
musculoskeletal diseases ,Adult ,Male ,medicine.medical_specialty ,renal failure ,medicine.medical_treatment ,Quadriceps tendon, spontaneous rupture, renal failure, lengthening plasty ,Pain ,Case Report ,Quadriceps tendon ,End stage renal disease ,law.invention ,Quadriceps Muscle ,law ,Tendon Injuries ,medicine ,Humans ,Radiogram ,Surgical repair ,Rupture ,lcsh:R5-920 ,Rehabilitation ,lengthening plasty ,business.industry ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,spontaneous rupture ,Knee pain ,medicine.anatomical_structure ,Rheumatoid arthritis ,Kidney Failure, Chronic ,Hemodialysis ,medicine.symptom ,lcsh:Medicine (General) ,business - Abstract
Spontaneous ruptures of the quadriceps tendon are infrequent injuries, it is seen primarily in patients with predisposing diseases such as gout, rheumatoid arthritis and chronic renal failure. A 32-year-old man had a history of end stage renal disease and received regular hemodialysis treatment for more than 5 years. He was admitted in our service for total functional impotence of the right lower limb with knee pain after a common fall two months ago. The radiogram showed a ‘’patella baja” with suprapatellar calcifications. The ultrasound and MRI showed an aspect of rupture of the quadriceps tendon in its proximal end with retraction of 3 cm. Quadriceps tendon repair was performed with a lengthening plasty, and the result was satisfactory after a serial rehabilitation program. The diagnosis of quadriceps tendon ruptures needs more attention in patientswith predisposing diseases. They should not be unknown because the treatment of neglected lesions is more difficult. We insist on the early surgical repair associated with early rehabilitation that can guarantee recovery of good active extension.Key words: Quadriceps tendon, spontaneous rupture, renal failure, lengthening plasty
- Published
- 2013
35. Opioid and benzodiazepine use in end-stage renal disease: a systematic review
- Author
-
Raman Rai, Ahraaz Wyne, William F. Clark, Rita S. Suri, and Meaghan S. Cuerden
- Subjects
medicine.medical_specialty ,Epidemiology ,medicine.drug_class ,medicine.medical_treatment ,Population ,Pain ,Critical Care and Intensive Care Medicine ,Risk Assessment ,End stage renal disease ,Benzodiazepines ,Risk Factors ,Internal medicine ,medicine ,Humans ,education ,Adverse effect ,Dialysis ,Pain Measurement ,Transplantation ,education.field_of_study ,Benzodiazepine ,business.industry ,Incidence (epidemiology) ,Mental Disorders ,Chronic pain ,Central Nervous System Depressants ,Original Articles ,medicine.disease ,Drug Utilization ,Analgesics, Opioid ,Treatment Outcome ,Opioid ,Nephrology ,Anesthesia ,Kidney Failure, Chronic ,business ,medicine.drug - Abstract
Summary Background and objectives Chronic pain and psychiatric disorders are common in dialysis patients, but the extent to which opioids and benzodiazepines are used is unclear. We conducted a systematic review to determine the: (1) prevalence of opioid and benzodiazepine use among dialysis patients; (2) reasons for use; (3) effectiveness of symptom control; and (4) incidence of adverse events. Design, setting, participants, & measurements Two authors reviewed all relevant citations in MEDLINE/ EMBASE/CINAHL/BIOSIS Previews/Cochrane and hand-searched bibliographies. Studies after 1990 reporting prevalence estimates for opioid and/or benzodiazepine use in 50 dialysis patients were included. Results We identified 15 studies from 12 countries over 1995 to 2006. Sample size ranged from 75 to 12,782. Prevalence of opioid and benzodiazepine use was variable, ranging from 5 to 36% (95% CI, 4.1 to 45.5%; n 10) and 8 to 26% (95% CI, 7.1 to 27.3%; n 9), respectively. Prevalence was positively correlated with years on dialysis. Five studies reported on the same cohorts but gave different prevalence estimates. One study verified medication use through patient interviews. Reasons for use were reported in one study. Effectiveness of pain control varied from 17 to 38%, and 72 to 84% of patients with significant pain had no analgesia (n 2). No study rigorously examined for adverse events. Conclusions The prevalence of opioid and benzodiazepine use in dialysis patients is highly variable between centers. Further information is needed regarding the appropriateness of these prescriptions, adequacy of symptom control, and incidence of adverse effects in this population. Clin J Am Soc Nephrol 6: 326–333, 2011. doi: 10.2215/CJN.04770610
- Published
- 2010
36. Impact of pain and symptom burden on the health-related quality of life of hemodialysis patients
- Author
-
Sara N. Davison and Gian S. Jhangri
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pain ,Context (language use) ,Disease ,End stage renal disease ,Quality of life ,Cost of Illness ,Renal Dialysis ,medicine ,Humans ,General Nursing ,Dialysis ,Depression (differential diagnoses) ,Aged ,business.industry ,Middle Aged ,medicine.disease ,Anesthesiology and Pain Medicine ,Physical therapy ,Quality of Life ,Anxiety ,Kidney Failure, Chronic ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Kidney disease - Abstract
Context Dialysis patients experience tremendous symptom burden and substantial impaired health-related quality of life (HRQL). Objectives We determined the association between symptom burden and HRQL in 591 hemodialysis patients. Methods Patients completed the modified Edmonton Symptom Assessment System and the Kidney Dialysis Quality of Life Short Form at baseline and after six months. Results There were no demographic, serological, or dialysis-related predictors for either HRQL or symptom burden. Pain, tiredness, lack of well-being, and depression were the only independent predictors of mental HRQL, accounting for 42.5% of the variation in the baseline mental health composite (MHC). Pain, fatigue, lack of well-being, and shortness of breath were the only independent predictors of physical HRQL, accounting for 38.5% of the variation in the baseline physical health composite (PHC). After follow-up, only changes in depression, anxiety, tiredness, and lack of appetite were independently associated with a change in MHC score, accounting for 48.7% of the variability. Only changes in pain, tiredness, and lack of appetite were independently associated with a change in PHC, accounting for 44.6% of the variability in the final multivariate regression model. No change in biochemical parameters predicted a change in either the MHC or the PHC. Conclusion Symptom burden in end-stage renal disease was substantial and had a tremendous negative impact on all aspects of hemodialysis patients' HRQL. These patients, therefore, would likely benefit from the institution of programs to reduce symptom burden.
- Published
- 2009
37. The prevalence of symptoms in end-stage renal disease: a systematic review
- Author
-
Julia Addington-Hall, Irene J Higginson, and Fliss E M Murtagh
- Subjects
Adult ,Sleep Wake Disorders ,medicine.medical_specialty ,Constipation ,Nausea ,medicine.medical_treatment ,Pain ,Disease ,Anxiety ,End stage renal disease ,Renal Dialysis ,Internal medicine ,Restless Legs Syndrome ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Dialysis ,Depression (differential diagnoses) ,Sleep disorder ,business.industry ,Depression ,Pruritus ,medicine.disease ,Nephrology ,Physical therapy ,Kidney Failure, Chronic ,medicine.symptom ,business - Abstract
Symptoms in end-stage renal disease (ESRD) are underrecognized. Prevalence studies have focused on single symptoms rather than on the whole range of symptoms experienced. This systematic review aimed to describe prevalence of all symptoms, to better understand total symptom burden. Extensive database, "gray literature," and hand searches were undertaken, by predefined protocol, for studies reporting symptom prevalence in ESRD populations on dialysis, discontinuing dialysis, or without dialysis. Prevalence data were extracted, study quality assessed by use of established criteria, and studies contrasted/combined to show weighted mean prevalence and range. Fifty-nine studies in dialysis patients, one in patients discontinuing dialysis, and none in patients without dialysis met the inclusion criteria. For the following symptoms, weighted mean prevalence (and range) were fatigue/tiredness 71% (12% to 97%), pruritus 55% (10% to 77%), constipation 53% (8% to 57%), anorexia 49% (25% to 61%), pain 47% (8% to 82%), sleep disturbance 44% (20% to 83%), anxiety 38% (12% to 52%), dyspnea 35% (11% to 55%), nausea 33% (15% to 48%), restless legs 30% (8%to 52%), and depression 27% (5%to 58%). Prevalence variations related to differences in symptom definition, period of prevalence, and level of severity reported. ESRD patients on dialysis experience multiple symptoms, with pain, fatigue, pruritus, and constipation in more than 1 in 2 patients. In patients discontinuing dialysis, evidence is more limited, but it suggests they too have significant symptom burden. No evidence is available on symptom prevalence in ESRD patients managed conservatively (without dialysis). The need for greater recognition of and research into symptom prevalence and causes, and interventions to alleviate them, is urgent.
- Published
- 2007
38. Efficacy of the world health organization analgesic ladder to treat pain in end-stage renal disease
- Author
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Ahmad S. Barakzoy and Alvin H. Moss
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Analgesic ,Population ,Pain ,World Health Organization ,Drug Administration Schedule ,End stage renal disease ,Internal medicine ,medicine ,Humans ,Prospective Studies ,education ,Prospective cohort study ,Aged ,education.field_of_study ,Analgesics ,business.industry ,General Medicine ,medicine.disease ,Nephrology ,McGill Pain Questionnaire ,Anesthesia ,Cohort ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business ,Kidney disease - Abstract
Pain is the one of the most common symptoms experienced by patients with ESRD; it impairs their quality of life and is undertreated. Most pain clinicians believe that the pain management approach of the World Health Organization (WHO) three-step analgesic ladder is applicable to the treatment of patients with ESRD, but this approach has not been validated for them. A cohort of 45 hemodialysis patients were assessed for type and severity of pain using the Short-Form McGill Pain Questionnaire and then treated during a 4-wk period according to the WHO analgesic ladder. Mean age was 65 +/- 12.5 yr, and 22 (49%) patients had diabetic nephropathy as the cause of ESRD. Initial pain was rated severe by 34 (76%) patients. There was no difference in initial pain rating by gender, age, race, or type of pain. Forty percent of patients reported nociceptive pain, 31% neuropathic, and 29% both. Adequate analgesia was achieved in 43 (96%) of 45 patients. The mean pain score decreased from 7.8 +/- 1.2 to 1.6 +/- 1.3 (P < 0.001). Patients who were 65 yr and older had higher posttreatment scores than those who were younger than 65 (2.1 +/- 1.4 versus 0.94 +/- 0.93; P = 0.002) and more medication adverse effects. It is concluded that the use of the WHO three-step analgesic ladder leads to effective pain relief in hemodialysis patients. Older patients will need more careful pain management to achieve the same results as younger patients. Further studies are needed to confirm these results in a larger, more diverse dialysis population.
- Published
- 2006
39. Theoretical conformational analysis of antidepressant as a way for evaluation of their efficiency for pain and itch syndrome management in patients with end-stage renal disease under chronic hemodialysis
- Author
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N. N. Shestakova and N. P. Vanchakova
- Subjects
medicine.medical_specialty ,business.industry ,Pruritus ,Biophysics ,Molecular Conformation ,Pain ,General Chemistry ,General Medicine ,Syndrome ,Biochemistry ,Antidepressive Agents ,End stage renal disease ,Text mining ,Renal Dialysis ,Internal medicine ,Drug Design ,medicine ,Antidepressant ,Humans ,Kidney Failure, Chronic ,Chronic hemodialysis ,In patient ,business - Published
- 2006
40. Subcutaneous nodules in a child on long-term dialysis: Questions.
- Author
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El-Desoky, Sherif, Bockenhauer, Detlef, Shroff, Rukshana, and Kari, Jameela
- Subjects
- *
TREATMENT of chronic kidney failure , *BONES , *CHRONIC kidney failure , *EDEMA , *FINGERS , *HEMODIALYSIS , *PAIN , *TOMOGRAPHY , *X-rays - Abstract
A quiz concerning the case study of a 15-year-old Saudi Arabian boy presented with painless hard subcutaneous swellings in his fingers with intact overlying skin is presented.
- Published
- 2014
- Full Text
- View/download PDF
41. A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study
- Author
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M. Yurtkuran, A. Alp, K. Dilek, Uludağ Üniversitesi/Tıp Fakültesi/Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı., Uludağ Üniversitesi/Tıp Fakültesi/Nefroloji Anabilim Dalı., Yurtkuran, Merih, Alp, Alev, Yurtkuran, Mustafa Abbas, Dilek, Kevser, and ABG-2019-2020
- Subjects
Male ,medicine.medical_treatment ,Relaxation training ,Blood Pressure ,Hematocrit ,Biochemistry ,Trial ,Turkey (republic) ,Low-back-pain ,law.invention ,Body Mass Index ,Manifestations ,End-stage renal disease ,Hatha Yoga ,Grip strength ,Randomized controlled trial ,law ,Complementary ,Controlled clinical trial ,Urea ,Treatment outcome ,Visual analog scale ,Range of Motion, Articular ,High density lipoprotein cholesterol ,Range of motion ,Fatigue ,Stage renal-disease ,Biological markers ,medicine.diagnostic_test ,Hand Strength ,Rehabilitation ,Phosphorus ,Single blind procedure ,Sleep disorders ,Low back pain ,humanities ,Integrative & complementary medicine ,Outpatient department ,Clinical trial ,Patient safety ,Cholesterol ,Hemodialysis ,Creatinine ,Yoga ,Dhyana ,Meditation ,Female ,medicine.symptom ,Human ,Complementary and Manual Therapy ,Adult ,Sleep Wake Disorders ,medicine.medical_specialty ,Pain assessment ,Visual analogue scale ,Pain ,Kidney failure ,Intervention ,Major clinical study ,Triacylglycerol ,Treatment duration ,End stage renal disease ,Hemodialysis patient ,Renal Dialysis ,Alkaline phosphatase ,Hatha yoga ,medicine ,Humans ,Pain Management ,Exercise ,University hospital ,Advanced and Specialized Nursing ,Sleep disorder ,business.industry ,Erythrocyte count ,Outcome assessment ,Complementary and alternative medicine ,Therapies ,Symptoms ,Physical therapy ,Calcium ,business ,Controlled study ,Biomarkers - Abstract
Summary Aim To evaluate the effects of a yoga-based exercise program on pain, fatigue, sleep disturbance, and biochemical markers in hemodialysis patients. Materials and methods In 2004 a randomized controlled trial was carried out in the outpatient hemodialysis unit of the Nephrology Department, Uludag University Faculty of Medicine. Clinically stable hemodialysis patients ( n = 37) were included and followed in two groups: the modified yoga-based exercise group ( n = 19) and the control group ( n = 18). Yoga-based exercises were done in groups for 30 min/day twice a week for 3 months. All of the patients in the yoga and control groups were given an active range of motion exercises to do for 10 min at home. The main outcome measures were pain intensity (measured by the visual analogue scale, VAS), fatigue (VAS), sleep disturbance (VAS), and grip strength (mmHg); biochemical variables – urea, creatinine, calcium, alkaline phosphatase, phosphorus, cholesterol, HDL-cholesterol, triglyceride, erythrocyte, hematocrit – were evaluated. Results After a 12-week intervention, significant improvements were seen in the variables: pain −37%, fatigue −55%, sleep disturbance −25%, grip strength +15%, urea −29%, creatinine −14%, alkaline phosphatase −15%, cholesterol −15%, erythrocyte +11%, and hematocrit count +13%; no side-effects were seen. Improvement of the variables in the yoga-based exercise program was found to be superior to that in the control group for all the variables except calcium, phosphorus, HDL-cholesterol and triglyceride levels. Conclusion A simplified yoga-based rehabilitation program is a complementary, safe and effective clinical treatment modality in patients with end-stage renal disease.
- Published
- 2005
42. Acupuncture in haemodialysis patients at the Quchi (LI11) acupoint for refractory uraemic pruritus
- Author
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Cheng Yu Wen, Kao Min-Tsung, Chou Che-yi, and Huang Chiu-Ching
- Subjects
Sleep Wake Disorders ,medicine.medical_specialty ,Uremic pruritus ,medicine.medical_treatment ,Pain ,Functional Laterality ,law.invention ,End stage renal disease ,Randomized controlled trial ,Refractory ,law ,Renal Dialysis ,Surveys and Questionnaires ,medicine ,Acupuncture ,Humans ,skin and connective tissue diseases ,Uremia ,Transplantation ,integumentary system ,business.industry ,Pruritus ,Repeated measures design ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Surgery ,Nephrology ,Anesthesia ,Kidney Failure, Chronic ,Hemodialysis ,business ,Acupuncture Points ,Kidney disease - Abstract
Background Uraemic pruritus is a common problem in end-stage renal failure patients. Traditional therapies produce marginal or no results. Acupuncture has been reported to be effective. The aim of this randomized, controlled study was to validate a single acupoint for relieving uraemic pruritus. Methods We randomized 40 patients with refractory uraemic pruritus into two groups. In group 1 (n = 20), acupuncture was applied unilaterally at the Quchi (LI11) acupoint thrice weekly for 1 month. In group 2 (controls, n = 20), acupuncture was applied at a non-acupoint 2 cm lateral to Quchi (LI11) thrice weekly for 1 month. Subjects responded to a pruritus score questionnaire given before and at the end of the 1 month treatment and at a 3 months follow-up. The results of the pruritus scores were analysed with the repeated measures general linear model to examine the effect of acupuncture on pruritus scores. Results In group 1, pruritus scores before and after acupuncture and at the 3 month follow-up were 38.3+/-4.3, 17.3+/-5.5 and 16.5+/-4.9, and in group 2 (controls) they were 38.3+/-4.3, 37.5+/-3.2 and 37.1+/-5, respectively. Laboratory tests showed no significant differences between the two groups. Pruritus scores were significantly lower after acupuncture and at the 3 month follow-up, P Conclusions Acupuncture at the Quchi (LI11) acupoint is an easy, safe and effective means of relieving uraemic pruritus.
- Published
- 2005
43. Gabapentin-induced myoclonus in end-stage renal disease
- Author
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Chunxiao Zhang, William L. Bell, Cormac A. O'Donovan, and Darren G. Glenn
- Subjects
Adult ,Male ,Myoclonus ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Spasm ,Gabapentin ,Cyclohexanecarboxylic Acids ,Pain ,Neurological disorder ,End stage renal disease ,Nephropathy ,Central nervous system disease ,Epilepsy ,mental disorders ,medicine ,Humans ,Paresthesia ,Amines ,gamma-Aminobutyric Acid ,business.industry ,Middle Aged ,medicine.disease ,nervous system diseases ,Surgery ,Neurology ,Anesthesia ,Kidney Failure, Chronic ,Anticonvulsants ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Kidney disease ,medicine.drug - Abstract
Summary: Purpose: We analyzed the occurrence and clinical features of myoclonus in patients with end-stage renal disease (ESRD) who were treated with gabapentin (GBP). Methods: We reviewed the medical records of patients with ESRD who were treated with GBP and hospitalized during an 18-month period and analyzed clinical details such as type of myoclonus, doses of GBP, electroencephalographic (EEG) findings, and relation of symptoms to GBP exposure and dosage. Results: Three of 71 patients had myoclonus with GBP doses ranging from 9 mg/kg to 20 mg/kg and within 4 months of treatment onset. Myoclonus was characterized as multifocal, involving all extremities in the three patients. EEG did not show epileptiform discharges with the myoclonus. Myoclonus resolved in the three individuals within 4‐15 days after GBP was discontinued. Conclusions: GBP increases the risk of myoclonus in ESRD. Myoclonus in these individuals was more disabling than that in patients with normal renal function, and discontinuation of GBP is required to restore normal function. Ke yW ords: Gabapentin—Myoclonus—End-stage renal disease.
- Published
- 2005
44. Incidence of chronic pain in patients with end-stage renal disease on dialysis
- Author
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Angelo Ferrantelli, Marco Lo Cicero, Armida Lo Cascio, Irene Parrino, Ignazio Cutaia, Calogera Tortorici, Sebastiano Mercadante, Alessandra Casuccio, MERCADANTE S, FERRANTELLI A, TORTORICI C, LO CASCIO A, LO CICERO M, CUTAIA I, PARRINO I, and CASUCCIO A
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Pain ,end-stage renal disease, dialysis ,End stage renal disease ,Text mining ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,In patient ,General Nursing ,Dialysis ,Aged ,business.industry ,Incidence ,Incidence (epidemiology) ,Chronic pain ,Middle Aged ,medicine.disease ,Anesthesiology and Pain Medicine ,Chronic disease ,Chronic Disease ,Kidney Failure, Chronic ,Female ,Neurology (clinical) ,business ,chronic pain - Published
- 2005
45. A case of difficult pain in a patient with chronic renal failure and calciphylaxis
- Author
-
Alison Rich, Austin Leach, and John Ellershaw
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Pain ,End stage renal disease ,medicine ,Humans ,Pain Management ,General Nursing ,Dialysis ,Gangrene ,Calciphylaxis ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Kidney Failure, Chronic ,Neurology (clinical) ,Hemodialysis ,business ,Penis ,Kidney disease - Abstract
A difficult pain occurred in a man with chronic renal failure as a result of the underlying condition of calciphylaxis. In this condition, calcification of small and medium-sized arteries occurs, which may result in ischemia and gangrene. In general, the prognosis is poor, with mortality rates ranging from 23-63%. Pain associated with this condition has been previously reported. In this report, the pain occurred in the lower limbs and penis, and was associated with local necrosis. The pain was observed to be significantly worse on dialysis. A multiprofessional approach to care ultimately resulted in good symptom control.
- Published
- 2001
46. A very good death: measuring quality of dying in end-stage renal disease
- Author
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David M. Poppel, Gary S. Reiter, Gabriel M. Cohn, and Lewis M. Cohen
- Subjects
Male ,medicine.medical_specialty ,Attitude to Death ,Time Factors ,medicine.medical_treatment ,Health Status ,Decision Making ,Pain ,End stage renal disease ,Fatal Outcome ,medicine ,Humans ,In patient ,Family ,Intensive care medicine ,General Nursing ,Dialysis ,Aged ,Pain Measurement ,Quality of Health Care ,Terminal Care ,business.industry ,General Medicine ,Discontinuation ,Anesthesiology and Pain Medicine ,Quality of Life ,Kidney Failure, Chronic ,business ,Advance Directives ,Good death ,Attitude to Health ,Peritoneal Dialysis - Abstract
A case is presented of an exceptionally good death after discontinuation of dialysis, and the authors trace the evolution of their attempts at measuring quality of dying in patients with end-stage renal disease. The Dialysis Quality of Dying Apgar is based on the pediatric tool for measuring the condition of newborn babies. Previous research with termination of dialysis has revealed that staff, patients, and families characterize a good death as being pain-free, peaceful, and brief. The quality of dying tool has corresponding domains to which it adds advance care planning and non-pain symptoms. Quantification of patient deaths combined with descriptive narratives can be used to establish benchmarks for the provision of terminal care. Very good deaths need to be recognized and valued as goals for palliative medicine.
- Published
- 2001
47. Recurrent pain, illness intrusiveness, and quality of life in end-stage renal disease
- Author
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Ronald B. Hons, Sherry Buckle, Susan Armstrong, Kenneth Taub, P. K. Letourneau, Gerald M. Devins, Ellen Burgess, Samuel Schorr, Henry Mandin, and L. C. Paul
- Subjects
medicine.medical_specialty ,Self-Assessment ,genetic structures ,media_common.quotation_subject ,Pain ,Disease ,End stage renal disease ,Quality of life ,Recurrence ,medicine ,Humans ,media_common ,Muscle Cramp ,business.industry ,Headache ,Illness intrusiveness ,Recurrent pain ,Anesthesiology and Pain Medicine ,Neurology ,Feeling ,Physical therapy ,Quality of Life ,Kidney Failure, Chronic ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,Muscle cramp - Abstract
Repeated episodes of headache and muscle cramp were hypothesized to contribute to increased patient perceptions of illness intrusiveness and to compromised quality of life. Standard measures of pain, illness intrusiveness, and quality of life were obtained on 2 occasions, each 6 weeks apart, from 100 end-stage renal disease patients. The impact of recurrent muscle cramps on perceptions of illness intrusiveness was conditional upon the occurrence of headache symptoms. Perceptions of illness intrusiveness were significantly higher when both muscle cramp and headache symptoms occurred during one or more assessment intervals as compared to when muscle cramps or headaches, only, occurred. Illness-related concerns and general feelings of pessimism were also significantly higher among patients who experienced recurrent episodes of muscle cramp. Although no direct relations were observed between pain and other quality of life indicators, previous research has documented a relation between illness intrusiveness and quality of life. Recurrent pain problems, thus, appear to contribute to increased illness intrusiveness and to reduced quality of life in end-stage renal disease patients.
- Published
- 1990
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