The association between chronic musculoskeletal pain and clinical outcome in chronic kidney disease patients: a prospective cohort study

Ren Fail. 2019 Nov;41(1):257-266. doi: 10.1080/0886022X.2019.1596817.

Abstract

Background and objectives: Chronic musculoskeletal (MS) pain is common in chronic kidney disease (CKD) patients. The association of chronic MS pain and CKD progression has not yet been established.

Method: We conducted a prospective cohort study to evaluate the association of chronic MS pain and CKD progression of pre-dialysis CKD patients.

Result: A total of 53.2% of pre-dialysis CKD patients had chronic MS pain. Patients classified as progression and non-progression had a similar prevalence of chronic MS pain at baseline, and similar baseline use of NSAIDs and Chinese herbal medicines. Univariate Cox analysis indicated that chronic MS pain and baseline NSAID or Chinese herbal medicine use were not significantly associated with progression of CKD. But multivariate Cox regression found chronic MS pain was independently significantly associated with all-cause mortality (HR, 2.912, 95% CI, 1.004-8.444; p = .049). However, serum levels of hs-CRP were similar between those chronic MS pain patients and without chronic MS pain patients (4.96 ± 9.4 vs. 4.25 ± 13.3 mg/L, p = .535).

Conclusion: The CKD patients with chronic MS pain was independently and significantly associated with all-cause mortality, but not independently and significantly associated with CKD progression and composite endpoints. The inflammatory marker-hs-CRP was similar between CKD patients with and without chronic MS pain.

Keywords: Chronic musculoskeletal pain; all-cause mortality; chronic kidney disease; nonsteroidal anti-inflammatory drug; progression.

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • C-Reactive Protein / analysis
  • Chronic Pain / blood
  • Chronic Pain / drug therapy
  • Chronic Pain / epidemiology*
  • Chronic Pain / etiology
  • Disease Progression
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Pain / blood
  • Musculoskeletal Pain / drug therapy
  • Musculoskeletal Pain / epidemiology*
  • Musculoskeletal Pain / etiology
  • Prognosis
  • Prospective Studies
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / diagnosis*
  • Renal Insufficiency, Chronic / pathology
  • Risk Assessment
  • Severity of Illness Index

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • C-Reactive Protein

Grants and funding

This study was sponsored by the Chang Gung Memorial Hospital Research Projects (CMRPG260362-3, CMRPG2A0451-3, CMRPG2B0151-3, and CMRPG2E0251-3) to HJH.