Calcium, Parathyroid Hormone, and Vitamin D: Major Determinants of Chronic Pain

Published ahead of print on July 2, 2009
Clinical Journal of the American Society of Nephrology
© 2009 American Society of Nephrology
doi: 10.2215/CJN.00680109

Received January 30, 2009
Accepted on May 21, 2009
ORIGINAL ARTICLES
Calcium, Parathyroid Hormone, and Vitamin D: Major Determinants of Chronic Pain in Hemodialysis Patients
Eliezer Golan *{dagger}1, Isabelle Haggiag *, Pnina Os *, and Jacques Bernheim *{dagger}

*Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, and {dagger}Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

1 To whom correspondence should be addressed. E-mail: golanel@clalit.org.il.

Abstract

Background and objectives: 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.

Design, setting, participants, & measurements: 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 D3) 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.

http://cjasn.asnjournals.org/cgi/content/abstract/CJN.00680109v1