Prevalence, pattern, and determinants of musculoskeletal pain among maintenance hemodialysis patients: a cross-sectional analytical study

Background: Musculoskeletal pain is common but frequently under-recognized among patients receiving maintenance hemodialysis (MHD). It may impair mobility, sleep, daily activities, functional independence, and participation in dialysis treatment. This study evaluated the prevalence, clinical pattern, functional impact, and determinants of musculoskeletal pain among adults receiving MHD. Methods: This cross-sectional analytical study included 1,000 consecutive adults receiving MHD who attended the nephrology outpatient department of a tertiary care center between May 2021 and April 2026. Musculoskeletal pain was assessed during a single outpatient visit using an 11-point numerical rating scale and was characterized according to anatomical site, severity, duration, laterality, and functional impact. Demographic, clinical, dialysis-related, nutritional, and chronic kidney disease-mineral and bone disorder variables were compared between participants with and without pain. Independent factors associated with musculoskeletal pain were identified using multivariable logistic regression. Results: Musculoskeletal pain was reported by 620 participants, corresponding to a prevalence of 62.0%. Moderate pain was most common (54.5%), followed by severe pain (26.5%) and mild pain (19.0%). The knee (54.2%), lower back (46.5%), and shoulder (32.9%) were the most frequently affected sites. Functional limitation and pain-related sleep disturbance were reported by 53.9% and 46.1% of affected participants, respectively. In multivariable analysis, older age (p<0.001), female sex (p=0.041), diabetes mellitus (p=0.002), longer dialysis vintage (p<0.001), higher serum phosphate (p<0.001), higher alkaline phosphatase (p=0.001), higher intact parathyroid hormone (p<0.001), and vitamin D deficiency (p=0.001) were independently associated with greater odds of musculoskeletal pain. Higher hemoglobin (p=0.007) and serum albumin (p=0.003) were independently associated with lower odds of pain. Conclusions: Musculoskeletal pain affected nearly two-thirds of this MHD population and was frequently accompanied by functional limitation and sleep disturbance. Its independent associations with nutritional status, anemia, dialysis duration, and mineral-bone abnormalities suggest that structured pain assessment and targeted evaluation of potentially modifiable contributors should be incorporated into routine outpatient care of patients receiving maintenance hemodialysis.