# International variations in chronic kidney disease patients’ pain experience and its management

## TL;DR

This study finds that pain management and its impact on quality of life vary significantly among chronic kidney disease patients in Brazil, France, and the USA.

## Contribution

The study reveals international differences in analgesic prescriptions and their effects on patient-reported outcomes in non-dialysis chronic kidney disease.

## Key findings

- Opioids are prescribed nearly twice as often in the USA compared to Brazil and France.
- NSAIDs are frequently prescribed in Brazil, even in advanced CKD stages.
- Higher pain intensity correlates with poorer quality of life outcomes across all regions.

## Abstract

Chronic pain significantly impacts health-related quality of life (HRQOL) in patients with non-dialysis chronic kidney disease (ND-CKD), yet the management of pain in this population is challenging. We hypothesized that analgesic prescription practices vary internationally, influencing the pain experience and HRQOL of patients with stage 3–5 ND-CKD.

This descriptive, observational, multinational cohort study utilized data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps), enrolling adult patients from nephrology practices in Brazil, France and the USA between 2013 and 2020. Analgesic prescriptions within 6 months before HRQOL assessment were categorized as non-steroidal anti-inflammatory drugs (NSAIDs), opioids or other analgesics. HRQOL was measured using the Kidney Disease Quality of Life Short Form, assessing multiple subdomains.

Among 3945 patients, analgesics were most frequently prescribed in the USA across all CKD stages, with opioids prescribed nearly twice as often compared with Brazil and France. NSAIDs are frequently prescribed in Brazil, including in advanced CKD stages, contrasting sharply with practices in France and the USA. Higher reported pain intensity consistently correlated with poorer outcomes across all HRQOL subdomains.

This study identifies considerable international variability in pain reporting and analgesic prescription patterns in patients with stage 3–5 ND-CKD. Randomized controlled trials evaluating the efficacy and safety of analgesics are warranted to improve key patient-reported outcomes such as pain in patients with ND-CKD.