# Pain Interference in Maintenance Hemodialysis: A Single-Center Cross-Sectional Study Using the Pain Effects Scale (PES)

## TL;DR

This study explores how pain affects the lives of patients undergoing hemodialysis, finding that older age and heart disease are linked to greater pain interference.

## Contribution

The study identifies ischemic heart disease as a unique contributor to pain interference in hemodialysis patients, independent of standard clinical metrics.

## Key findings

- Older age is significantly correlated with higher pain interference scores.
- Patients with ischemic heart disease report significantly higher pain interference than those without.
- Pain interference is largely independent of standard dialysis adequacy metrics and most comorbidities.

## Abstract

Background: Pain is a common and clinically important symptom in hemodialysis, yet its functional impact and determinants remain insufficiently characterized. This study examined factors associated with pain interference using the Pain Effects Scale (PES) in maintenance hemodialysis patients. Methods: In a cross-sectional study, 73 adults receiving thrice-weekly hemodialysis completed the PES, assessing the four-week impact of pain on mood, sleep, mobility, work, recreation, and enjoyment of life. Demographic, clinical, and dialysis-related variables—including vascular access type, dialysis vintage, session duration, ultrafiltration volume, predialysis urea, Kt/V, urea reduction ratio, comorbidities, and transplant history—were extracted from medical records. Associations were evaluated using parametric and non-parametric tests. Results: PES scores indicated substantial pain interference. Older age was positively correlated with higher PES scores (r = 0.32, p = 0.006), and patients with ischemic heart disease had significantly higher PES values than those without (23.1 ± 6.7 vs. 17.3 ± 6.2; p = 0.012). Willingness to pursue transplantation showed a non-significant trend toward lower scores. Conclusions: Pain interference in hemodialysis appears largely independent of routine adequacy metrics and most comorbidities, with ischemic cardiovascular disease emerging as an exception. Findings underscore the need for a biopsychosocial approach integrating pain screening with assessment of mood, sleep, neuropathy, musculoskeletal factors, and ischemic symptoms.