The Prevalence and Severity of Chronic Pain in Patients with End-Stage Kidney Disease (ESKD) on Maintenance Hemodialysis

Background and Aim: Chronic pain is a common yet often underrecognized symptom in patients with end-stage kidney disease (ESKD) receiving maintenance hemodialysis. This study was conducted to determine the prevalence, severity, and associated clinical and biochemical factors of chronic pain in patients undergoing long-term hemodialysis at a tertiary care center in Multan, Pakistan. Materials and Methods: A descriptive cross-sectional study was conducted over six months (February 2024 to August 2024) at the dialysis units of Nishtar Hospital, Multan. A total of 150 adult ESKD patients on maintenance hemodialysis were enrolled using non-probability consecutive sampling. Data on demographics, comorbidities, dialysis duration, and laboratory parameters were collected. Chronic pain was defined as pain lasting ≥3 months and graded by the Numerical Rating Scale. Statistical associations were assessed using chi-square and independent sample t-tests. Results: Among 150 patients (mean age 52.4 ± 13.2 years; 58% male), 98 (65.3%) reported chronic pain. Of these, 28 (28.6%) had mild, 41 (41.8%) moderate, and 29 (29.6%) severe pain. Common pain sites included the lower back (34.7%) and lower limbs (26.5%). Chronic pain was more prevalent among females (74.6%, p = 0.034), diabetics (78.7%, p < 0.001), and patients with dialysis duration >24 months (79.8%, p < 0.001). Lower hemoglobin (p = 0.004), lower ferritin (p = 0.012), higher calcium-phosphate product (p = 0.007), and elevated iPTH levels (p = 0.003) were significantly associated with chronic pain. Conclusion: Chronic pain affects two-thirds of hemodialysis patients and is associated with demographic, clinical, and metabolic factors. Regular screening and targeted interventions should be integrated into dialysis care for symptom relief.