Öz
Amaç:
Kronik böbrek hastalığı (KBH) olan bireyler, analjeziklerin uygun olmayan kullanımına bağlı olarak başarısız ağrı yönetimi ve böbrek hasarı riski altındadır. Bu çalışmada diyalize bağımlı olmayan KBH’si olan geriyatrik bir popülasyonda kronik muskuloskeletal ağrı (KMA) prevalansının ve analjezik kullanım alışkanlıklarının yanı sıra steroidal olmayan anti-enflamatuvar ilaçların (NSAİİ) ve/veya parasetamol kullanım sıklığının araştırılması amaçlanmıştır.
Yöntem:
Bu tek merkezli kesitsel çalışma, nefroloji kliniğinde en az 1 yıldır diyalize bağımlı olmayan KBH nedeniyle takip edilen 65 yaş üstü hastaları içermektedir. Kronik ağrı, Cornell kas-iskelet rahatsızlık anketi ile değerlendirildi. Ağrı şiddeti, görsel analog skala (VAS) kullanılarak değerlendirildi.
Sonuç:
KBH’li yaşlı hastalarda KMA sıklığı, NSAİİ kullanımı ve reçetelenmesinin sıklığının yüksek olmasından ötürü, bu hastalarda doğru bir risk değerlendirmesi KBH evresi, yaş, komorbid durumlar ve eşzamanlı ilaç kullanımına göre bireyselleştirilmelidir.
Bulgular:
İki yüz altmış dokuz KBH hastasının 142’sinde (%52,8) KMA olduğu belirlendi. KMA olan hastalar, olmayan bireylerden daha yaşlıydı (p=0,042). Yüz yirmi dokuz erkek hasta ve 140 kadın hasta mevcuttu. KMA olan hastalarda kadın oranı ve ortalama vücut kitle indeksi, KMA olmayan hastalara göre önemli ölçüde daha yüksekti (p=0,0001). Hastaların %9,7’si genel olarak parasetamol kullanırken, %42,8’i NSAİİ kullanmıştı. KMA olmayan hastaların %10,2’sinde ve olan hastalarının %71,8’inde NSAİİ kullanımı mevcuttu (p=0,0001). KMA’lı hastalarda ortalama VAS skoru 5,01±2,07 idi ve bunların %48,6’sı orta ila şiddetli ağrı bildirdi. Analjezik tipinden bağımsız olarak VAS skoru ve tahmini glomerüler filtrasyon hızı düzeyi benzerdi. Olguların %57,8’ine aile hekimlerinin, %9,0’ına acil servis hekimlerinin, %17,5’ine ortopedi hekimlerinin ve %15,7’sine başka uzmanların NSAİİ reçete ettiği belirlendi (p<0,0001).
Anahtar Kelimeler: Analjezikler, kronik böbrek hastalığı, kronik muskuloskeletal ağrı, geriyatrik popülasyon
Kaynakça
Weckmann GFC, Stracke S, Haase A, Spallek J, Ludwig F, Angelow A, et al. Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines. BMC Nephrol 2018;19(1):258.
Suckling R, Gallagher H. Chronic kidney disease, diabetes mellitus and cardiovascular disease: risks and commonalities. J Ren Care 2012;38(Suppl 1):4-11.
Dos Santos PR, Mendonça CR, Hernandes JC, Borges CC, Barbosa MA, Romeiro AMS, et al. Pain in Patients With Chronic Kidney Disease Undergoing Hemodialysis: A Systematic Review. Pain Manag Nurs 2021;22(5):605-615.
Wu J, Ginsberg JS, Zhan M, Diamantidis CJ, Chen J, Woods C, et al. Chronic pain and analgesic use in CKD: implications for patient safety. Clin J Am Soc Nephrol 2015;10(3):435-442.
Whittaker CF, Miklich MA, Patel RS, Fink JC. Medication Safety Principles and Practice in CKD. Clin J Am Soc Nephrol 2018;13(11):1738-1746.
Ravel V, Ahmadi SF, Streja E, Sosnov JA, Kovesdy CP, Kalantar-Zadeh K, Chen JLT. Pain and Kidney Function Decline and Mortality: A Cohort Study of US Veterans. Am J Kidney Dis 2016;68(2):240-246.
Davison SN, Koncicki H, Brennan F. Pain in chronic kidney disease: a scoping review. Semin Dial 2014;27(2):188-204.
Koncicki HM, Unruh M, Schell JO. Pain Management in CKD: A Guide for Nephrology Providers. Am J Kidney Dis 2017;69(3):451-460.
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019;67(4):674-694.
Han Y, Balkrishnan R, Hirth RA, Hutton DW, He K, Steffick DE, et al. Assessment of Prescription Analgesic Use in Older Adults With and Without Chronic Kidney Disease and Outcomes. JAMA Netw Open 2020;3(9):e2016839.
Leo RJ. Safe analgesic use in patients with renal dysfunction. Pract Pain Manag 2008;8(5).
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA 2016;315(15):1624-1645.
Erdinc O, Hot K, Ozkaya M. Turkish version of the Cornell Musculoskeletal Discomfort Questionnaire: cross-cultural adaptation and validation. Work 2011;39(3):251-260.
World Health Organization. Cancer pain relief: with a guide to opioid availability. 2nd ed. Geneva: Who, 1996:15-16.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-612. Erratum in: Ann Intern Med 2011;155(6):408.
Levin A, Stevens PE, Bilous RW, Coresh J, De Francisco ALM, De Jong PE, et al. Kidneydisease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International 2013;3(1):1-150.
Thompson A, Lawrence J, Stockbridge N. GFR decline as an end point in trials of CKD: a viewpoint from the FDA. Am J Kidney Dis 2014;64(6):836-837.
Jha V, Wang AY, Wang H. The impact of CKD identification in large countries: the burden of illness. Nephrol Dial Transplant 2012;27(Suppl 3):iii32-iii38.
Pham PC, Dewar K, Hashmi S, Toscano E, Pham PM, Pham PA, et al. Pain prevalence in patients with chronic kidney disease. Clin Nephrol 2010;73(4):294-299.
Davison SN, Jhangri GS. The impact of chronic pain on depression, sleep, and the desire to withdraw from dialysis in hemodialysis patients. J Pain Symptom Manage 2005;30(5):465-473.
Hsu HJ, Wu IW, Hsu KH, Sun CY, Hung MJ, Chen CY, et al. The association between chronic musculoskeletal pain and clinical outcome in chronic kidney disease patients: a prospective cohort study. Ren Fail 2019;41(1):257-266. Erratum in: Ren Fail 2020;42(1):304.
Caravaca F, Gonzales B, Bayo MÁ, Luna E. Musculoskeletal pain in patients with chronic kidney disease. Nefrologia 2016;36(4):433-440.
Sadean MR, Glass PS. Pharmacokinetics in the elderly. Best Pract Res Clin Anaesthesiol 2003;17(2):191-205.
Trescot AM, Helm S, Hansen H, Benyamin R, Glaser SE, Adlaka R, et al. Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician 2008;11(2 Suppl):S5-S62.
Tai FWD, McAlindon ME. Non-steroidal anti-inflammatory drugs and the gastrointestinal tract. Clin Med (Lond) 2021;21(2):131-134.
Yuhara H, Corley DA, Nakahara F, Nakajima T, Koike J, Igarashi M, et al. Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis. J Gastroenterol 2014;49(6):992-1000.
van Vollenhoven RF. Sex differences in rheumatoid arthritis: more than meets the eye. BMC Med 2009;7:12.
Al-Azayzih A, Al-Azzam SI, Alzoubi KH, Jarab AS, Kharaba Z, Al-Rifai RH, et al. Nonsteroidal Anti-inflammatory Drugs Utilization Patterns and Risk of Adverse Events due to Drug-Drug Interactions among Elderly Patients: A Study from Jordan. Saudi Pharm J 2020;28(4):504-508.
Motola D, Vaccheri A, Silvani MC, Poluzzi E, Bottoni A, De Ponti F, et al. Pattern of NSAID use in the Italian general population: a questionnaire-based survey. Eur J Clin Pharmacol 2004;60(10):731-738.
Hull S, Mathur R, Dreyer G, Yaqoob MM. Evaluating ethnic differences in the prescription of NSAIDs for chronic kidney disease: a cross-sectional survey of patients in general practice. Br J Gen Pract 2014;64(624):e448-e455.
Abd ElHafeez S, Hegazy R, Naga Y, Wahdan I, Sallam S. Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: an epidemiological study. J Egypt Public Health Assoc 2019;94(1):8.
Agodoa LY, Francis ME, Eggers PW. Association of analgesic use with prevalence of albuminuria and reduced GFR in US adults. Am J Kidney Dis 2008;51(4):573-583.
Kurth T, Glynn RJ, Walker AM, Rexrode KM, Buring JE, Stampfer MJ, et al. Analgesic use and change in kidney function in apparently healthy men. Am J Kidney Dis 2003;42(2):234-244.
Zhan M, Doerfler RM, Xie D, Chen J, Chen HY, Diamantidis CJ, et al. Association of Opioids and Nonsteroidal Anti-inflammatory Drugs With Outcomes in CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis 2020;76(2):184-193.
Bouck Z, Mecredy GC, Ivers NM, Barua M, Martin D, Austin PC, et al. Frequency and Associations of Prescription Nonsteroidal Anti-inflammatory Drug Use Among Patients With a Musculoskeletal Disorder and Hypertension, Heart Failure, or Chronic Kidney Disease. JAMA Intern Med 2018;178(11):1516-1525.
Ingrasciotta Y, Sultana J, Giorgianni F, Menditto E, Scuteri A, Tari M, et al. Analgesic drug use in elderly persons: A population-based study in Southern Italy. PLoS One 2019;14(9):e0222836.
Kaplan C, Bilge U, Acar N, Unluoglu I. Determination of polypharmacy and inappropriate drug use in patients aged over 65 years who presented to the emergency department. Turk J Geriatr 2019;22(3):287-294.
Rosenberg A, Agiro A, Gottlieb M, Barron J, Brady P, Liu Y, et al. Early Trends Among Seven Recommendations From the Choosing Wisely Campaign. JAMA Intern Med 2015;175(12):1913-1920. Erratum in: JAMA Intern Med 2015;175(12):2003.
Ndlovu M, Bedson J, Jones PW, Jordan KP. Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data. BMC Musculoskelet Disord 2014;15:418.
Visser LE, Graatsma HH, Stricker BH. Contraindicated NSAIDs are frequently prescribed to elderly patients with peptic ulcer disease. Br J Clin Pharmacol 2002;53(2):183-188.
Nash DM, Markle-Reid M, Brimble KS, McArthur E, Roshanov PS, Fink JC, et al. Nonsteroidal anti-inflammatory drug use and risk of acute kidney injury and hyperkalemia in older adults: a population-based study. Nephrol Dial Transplant 2019;34(7):1145-1154.
Bilge U, Sahin G, Unluoglu I, Ipek M, Durdu M, Keskin A. Inappropriate use of nonsteroidal anti-inflammatory drugs and other drugs in chronic kidney disease patients without renal replacement therapy. Ren Fail 2013;35(6):906-910.
Davison SN. Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure. Clin J Am Soc Nephrol 2019;14(6):917-931.
Baker ML, Perazella MA. Can NSAIDs Be Used Safely for Analgesia in Patients with CKD?: COMMENTARY. Kidney360 2020;1(11):1192-1194.
Arakawa T, Fujiwara Y, Sollano JD, Zhu Q, Kachintorn U, Rani AA, et al. A questionnaire-based survey on the prescription of non-steroidal anti-inflammatory drugs by physicians in East Asian countries in 2007. Digestion 2009;79(3):177-185.
Cetin M, Kaya B, Kilic TY, Hanoğlu ND, Gökhan Ş, Eroğlu SE, et al. Pain management practices in the emergency departments in Turkey. Turk J Emerg Med 2021;21(4):189-197.
