Calcium, parathyroid hormone, and vitamin D: major determinants of chronic pain in hemodialysis patients.
OBJECTIVE
Pain is a frequent complaint of hemodialysis (HD) patients, yet information regarding its causes and frequency is relatively scarce. The aim of this study was to evaluate the frequency and possible causes of chronic pain in patients who are on long-term HD.


METHODS
We prospectively enrolled 100 patients who were undergoing maintenance HD for at least 3 mo. Pain was evaluated using the Brief Pain Inventory. Data collected on each participant included age, gender, ethnic origin, body mass index, smoking habits, time on dialysis, type of blood access, comorbidities, and biochemical and hematologic parameters.


RESULTS
The average age was 64.5 yr; the average time on dialysis 40.4 mo. Forty-five patients were male. Thirty-one participants were of Arabic origin. Fifty-three patients had diabetes, 36 of whom had diabetic retinopathy. Although 51 patients experienced chronic pain, only 19.6% described the pain as severe. Musculoskeletal pain, neuropathic pain, and headache were the most prevalent forms of pain. The presence of diabetic retinopathy and neuropathy (but not diabetes per se) and levels of intact parathyroid hormone, calcium, and calcitriol (but not 25-hydroxyvitamin D(3)) differed significantly between those who experienced chronic pain and those who did not. On a logistic regression model, higher serum calcium levels and intact parathyroid hormone levels >250 pg/ml were independently associated with chronic pain, as well as the presence of diabetic retinopathy. Calcitriol had a marginal effect.


CONCLUSIONS
Disturbed mineral metabolism is strongly associated with chronic pain in long-term HD patients, along with microangiopathy.
Golan
Eliezer
E
Department of Nephrology and Hypertension, Meir Medical Center, 59 Tchernichovsky Street, Kfar Saba 44281, Israel. golanel@clalit.org.il
Haggiag
Isabelle
I
Os
Pnina
P
Bernheim
Jacques
J
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002117:Calcitriol / Q000097:blood*; D002118:Calcium / Q000097:blood*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003929:Diabetic Neuropathies / Q000150:complications; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000097:blood / Q000209:etiology*; D010147:Pain Measurement; D010281:Parathyroid Hormone / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D015415:Biomarkers; D010281:Parathyroid Hormone; D002117:Calcitriol; D002118:Calcium