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Pain and Kidney Function Decline and Mortality: A Cohort Study of US Veterans.
Am J Kidney Dis. 2016 08; 68(2):240-246.AJ

Abstract

BACKGROUND

Chronic pain is a common condition in the general population. However, large epidemiologic studies examining the role of pain in the deterioration of kidney function, development of chronic kidney disease, and risk for death are lacking.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

A nationally representative cohort of 2,360,056 US veterans with baseline estimated glomerular filtration rates (eGFRs) ≥ 60mL/min/1.73m(2), followed up from October 2004 to September 2006.

PREDICTOR

4 pain categories were compared: none (score, 0), mild (1-4), moderate (5-6), or severe (≥7).

OUTCOMES

eGFR decline (determined by eGFR slope) and combined incident eGFR<60mL/min/1.73m(2) or all-cause death.

MEASUREMENTS

We examined the pain management pattern and association of reported pain with (1) rapid eGFR decline and (2) a composite outcome of incident eGFR<60mL/min/1.73m(2) or all-cause death using logistic regression and Cox models adjusted for baseline eGFR, demographics, comorbid conditions, cardiovascular risk factors, and depression.

RESULTS

∼60% of veterans reported pain of any severity during the baseline period. The most commonly prescribed analgesics were opioids. In a dose-response relationship, veterans reporting moderate or severe pain had a higher risk for faster eGFR decline compared with those reporting none (ORs of 1.11 [95% CI, 1.09-1.14] and 1.17 [95% CI, 1.13-1.21] for moderate and severe pain, respectively). In combined analyses, veterans reporting moderate or severe pain both had 30% higher risk of the combined outcome (incident eGFR, 60 mL/min/1.73 m(2) or death) compared with those reporting none (HRs of 1.30 [95% CI, 1.28-1.31] and 1.30 [95% CI, 1.28-1.32] for moderate and severe pain, respectively).

LIMITATIONS

Lack of granular data regarding type and location of pain.

CONCLUSIONS

We observed a high prevalence of pain and analgesic prescription in the US veteran population with normal eGFRs. Pain was associated with a higher incidence of eGFRs<60mL/min/1.73m(2), faster kidney function decline, and higher mortality.

Authors+Show Affiliations

Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Health, Orange, CA.Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Health, Orange, CA.Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Health, Orange, CA.Division of Nephrology, Department of the Air Force 59th Medical Wing (AETC), Joint Base San Antonio-Lackland, TX.Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN; Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN.Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Health, Orange, CA; Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA. Electronic address: kkz@uci.edu.Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Health, Orange, CA; Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA. Electronic address: joline.chen@va.gov.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27108099

Citation

Ravel, Vanessa, et al. "Pain and Kidney Function Decline and Mortality: a Cohort Study of US Veterans." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 2, 2016, pp. 240-246.
Ravel V, Ahmadi SF, Streja E, et al. Pain and Kidney Function Decline and Mortality: A Cohort Study of US Veterans. Am J Kidney Dis. 2016;68(2):240-246.
Ravel, V., Ahmadi, S. F., Streja, E., Sosnov, J. A., Kovesdy, C. P., Kalantar-Zadeh, K., & Chen, J. L. T. (2016). Pain and Kidney Function Decline and Mortality: A Cohort Study of US Veterans. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(2), 240-246. https://doi.org/10.1053/j.ajkd.2016.02.048
Ravel V, et al. Pain and Kidney Function Decline and Mortality: a Cohort Study of US Veterans. Am J Kidney Dis. 2016;68(2):240-246. PubMed PMID: 27108099.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pain and Kidney Function Decline and Mortality: A Cohort Study of US Veterans. AU - Ravel,Vanessa, AU - Ahmadi,Seyed-Foad, AU - Streja,Elani, AU - Sosnov,Jonathan A, AU - Kovesdy,Csaba P, AU - Kalantar-Zadeh,Kamyar, AU - Chen,Joline L T, Y1 - 2016/04/20/ PY - 2015/10/29/received PY - 2016/02/17/accepted PY - 2016/4/25/entrez PY - 2016/4/25/pubmed PY - 2017/6/1/medline KW - CKD progression KW - Chronic pain KW - analgesics KW - chronic kidney disease (CKD) KW - glomerular filtration rate (GFR) KW - kidney disease trajectory KW - mortality KW - nonsteroidal anti-inflammatory drug (NSAID) KW - opioid KW - pain medication KW - renal function KW - veterans SP - 240 EP - 246 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 2 N2 - BACKGROUND: Chronic pain is a common condition in the general population. However, large epidemiologic studies examining the role of pain in the deterioration of kidney function, development of chronic kidney disease, and risk for death are lacking. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: A nationally representative cohort of 2,360,056 US veterans with baseline estimated glomerular filtration rates (eGFRs) ≥ 60mL/min/1.73m(2), followed up from October 2004 to September 2006. PREDICTOR: 4 pain categories were compared: none (score, 0), mild (1-4), moderate (5-6), or severe (≥7). OUTCOMES: eGFR decline (determined by eGFR slope) and combined incident eGFR<60mL/min/1.73m(2) or all-cause death. MEASUREMENTS: We examined the pain management pattern and association of reported pain with (1) rapid eGFR decline and (2) a composite outcome of incident eGFR<60mL/min/1.73m(2) or all-cause death using logistic regression and Cox models adjusted for baseline eGFR, demographics, comorbid conditions, cardiovascular risk factors, and depression. RESULTS: ∼60% of veterans reported pain of any severity during the baseline period. The most commonly prescribed analgesics were opioids. In a dose-response relationship, veterans reporting moderate or severe pain had a higher risk for faster eGFR decline compared with those reporting none (ORs of 1.11 [95% CI, 1.09-1.14] and 1.17 [95% CI, 1.13-1.21] for moderate and severe pain, respectively). In combined analyses, veterans reporting moderate or severe pain both had 30% higher risk of the combined outcome (incident eGFR, 60 mL/min/1.73 m(2) or death) compared with those reporting none (HRs of 1.30 [95% CI, 1.28-1.31] and 1.30 [95% CI, 1.28-1.32] for moderate and severe pain, respectively). LIMITATIONS: Lack of granular data regarding type and location of pain. CONCLUSIONS: We observed a high prevalence of pain and analgesic prescription in the US veteran population with normal eGFRs. Pain was associated with a higher incidence of eGFRs<60mL/min/1.73m(2), faster kidney function decline, and higher mortality. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/27108099/Pain_and_Kidney_Function_Decline_and_Mortality:_A_Cohort_Study_of_US_Veterans_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)00695-8 DB - PRIME DP - Unbound Medicine ER -