Kidney Week

Abstract: TH-PO290

Chronic Pain Characteristics and Associated Symptoms in Patients on Maintenance Hemodialysis: Findings from the HOPE Consortium Trial

Session Information

• Hemodialysis and Frequent Dialysis - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Fischer, Michael J., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Michael J. Fischer, MD, MPH, FASN

• Hsu, Jesse Yenchih, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Jesse Yenchih Hsu, PhD

• Walsh, Joanna, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Joanna Walsh, MS

• Charytan, David M., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

David M. Charytan, MD, MS, MSc

• Crowley, Susan T., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Susan T. Crowley, MD, MBA, FASN

• Cukor, Daniel, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Daniel Cukor, PhD

• Dember, Laura M., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Laura M. Dember, MD, FASN

• Doorenbos, Ardith Zwyghuizen, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Ardith Zwyghuizen Doorenbos, PhD, RN

• Esserman, Denise, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Denise Esserman, MS, PhD

• Jhamb, Manisha, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Manisha Jhamb, MD, MPH

• Johansen, Kirsten L., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Kirsten L. Johansen, MD, FASN

• Keefe, Francis J., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Francis J. Keefe, PhD

• Kimmel, Paul L., National Institutes of Health, Bethesda, Maryland, United States

Paul L. Kimmel, MD, FASN

• Lockwood, Mark, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Mark Lockwood, PhD, RN

• Mehrotra, Rajnish, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Rajnish Mehrotra, MD, MS, FASN

• Morasco, Benjamin J., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Benjamin J. Morasco, PhD

• Nigwekar, Sagar U., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Sagar U. Nigwekar, MD

• Pun, Patrick H., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Patrick H. Pun, MD, MS, FASN

• Qamhiyeh, Raghd, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Raghd Qamhiyeh

• Scherer, Jennifer S., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Jennifer S. Scherer, MD, MS, FASN

• Schmidt, Rebecca J., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Rebecca J. Schmidt, DO, FASN

• Steel, Jennifer L., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Jennifer L. Steel, PhD

• Unruh, Mark L., HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Mark L. Unruh, MD, MS

• Yabes, Jonathan Guerrero, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Jonathan Guerrero Yabes, PhD

• Kalim, Sahir, HOPE Trial Consortium, Philadelphia, Pennsylvania, United States

Sahir Kalim, MD, MS, MSc, FASN

Background

Pain is one of the symptoms reported most frequently by maintenance hemodialysis (HD) patients. However, there is limited information on its etiologies, characteristics, and associations with other symptoms.

Methods

The HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis is a multicenter randomized trial to address chronic pain in adults receiving maintenance HD. We enrolled patients with moderate or severe chronic pain on maintenance HD at 103 dialysis facilities across the US from January 2021 to April 2023. Pain interference and severity were assessed by the Brief Pain Inventory (BPI) [range 0-10]. We used multivariable regression with LASSO to examine associations between pain interference/severity and participant characteristics, and Pearson’s correlation to examine relationships between pain interference/severity and other symptoms at enrollment.

Results

Among 643 participants, the median (IQR) BPI interference score was 6.6 (5.1-7.8) and severity score was 6.0 (4.5-7.5). 84% of participants experienced pain >1 year and 75% had daily pain. 89% of participants cited musculoskeletal pain and 66% cited neuropathic pain. The median (IQR) number of painful body regions was 8 (4-14), and the most common were lower back (~70%), knees (~50%), feet (~45%), neck (~40%), and hands (~40%). In multivariable regression analyses, female sex, unemployment, diabetes, cardiovascular disease, anxiety, and depression were associated with significantly greater pain interference whereas White race, non-Hispanic ethnicity, higher education, and greater years on dialysis were associated with significantly lower pain interference. PCS SF-6 (pain catastrophizing), PROMIS fatigue, PHQ-9 (depression), and GAD-7 (anxiety) scores were moderately correlated with BPI interference (r>0.4).

Conclusion

Among HD patients with chronic pain, pain characteristics were heterogeneous. Sociodemographic and psychological were more strongly associated with pain interference and severity than comorbidity and dialysis factors.

Funding

• NIDDK Support