Department of Medicine, George Washington University, Washington, DC, USA.
Nephrol Dial Transplant. 2012 Feb;27(2):758-65. doi: 10.1093/ndt/gfr355. Epub 2011 Jul 18.
Patients' perception of pain during hemodialysis (HD) and at times between HD treatment and its association with survival have not been well studied in end-stage renal disease (ESRD). We evaluated the experience of pain during HD and at times when the patient was not receiving HD, and assessed possible associations of the perception of pain and sleep disturbance with patient survival.
A total of 128 ESRD patients treated with HD completed questionnaires on psychosocial status, quality of life and sleep disorders. A modified McGill Pain questionnaire was used to assess the nature, location, frequency, intensity and duration of pain both during and at times between HD sessions. The Pittsburgh Sleep Quality Index was used to screen for sleep disturbances over a 30-day period.
Controlling for age, diabetes mellitus, serum albumin concentration and human immunodeficiency virus infection, there was a significant association between mortality and both frequency and intensity of pain while patients were not on HD. There was no association between survival and duration of pain while off HD or any of the pain parameters while patients were on HD. There was no association between survival and the presence of a sleep disorder.
Pain perception while off HD may be of more importance to patients than pain during HD. The mechanisms underlying the association are unknown but may involve linkage of pain with severity of medical illness or the generation of a maladaptive cytokine response. Multicenter prospective studies of pain interventions using well-validated pain perception tools are needed to establish causal relationships. Interventions directed toward treating pain on non-HD days may improve ESRD patient survival.
在终末期肾病（ESRD）患者中，人们尚未充分研究其在血液透析（HD）过程中以及在 HD 治疗期间和之后感到疼痛的情况及其与生存率的关系。我们评估了 HD 过程中和患者未接受 HD 时的疼痛体验，并评估了疼痛和睡眠障碍感知与患者生存的可能关联。
共有 128 名接受 HD 治疗的 ESRD 患者完成了关于社会心理状况、生活质量和睡眠障碍的问卷。使用改良的麦吉尔疼痛问卷评估 HD 期间和 HD 期间之间疼痛的性质、位置、频率、强度和持续时间。匹兹堡睡眠质量指数用于在 30 天内筛查睡眠障碍。
在控制年龄、糖尿病、血清白蛋白浓度和人类免疫缺陷病毒感染后，患者不在 HD 时的疼痛频率和强度与死亡率之间存在显著关联。患者不在 HD 时的疼痛持续时间或任何 HD 时的疼痛参数与生存率之间均无关联。生存与睡眠障碍之间也没有关联。
与 HD 期间的疼痛相比，患者在非 HD 时感知到的疼痛可能更为重要。其关联的潜在机制尚不清楚，但可能涉及疼痛与疾病严重程度的联系或产生适应性细胞因子反应。需要使用经过良好验证的疼痛感知工具进行针对疼痛干预的多中心前瞻性研究，以确定因果关系。针对非 HD 日疼痛的治疗干预可能会改善 ESRD 患者的生存率。
