Introduction:
Topicality: Patients with stage 5 chronic kidney disease (CKD) undergoing hemodialysis frequently suffer from chronic pain, which significantly impacts their quality of life. Due to the nephrotoxic effects of many analgesics, the choice of safe and effective pain relief options for these patients is limited. Acetaminophen is considered one of the safest medications for pain relief in CKD patients, but its long-term effects in stage 5 CKD patients need further investigation. This study seeks to address these gaps by examining the effectiveness and safety of acetaminophen specifically in this population.
Objective: To evaluate the effectiveness and safety of acetaminophen for pain relief in patients with stage 5 CKD on chronic hemodialysis, as well as its impact on quality of life and kidney function. Additionally, the study aims to provide recommendations for clinical practice and identify areas for further research.
Methods:
Methods: This prospective study included 100 patients with stage 5 CKD on hemodialysis, comprising 55 men and 45 women, aged between 35 and 65 years. Dialysis Duration: Patients had been on hemodialysis for 4 to 8 years. Pain Characteristics: The most common pain causes were tension-type headaches, pain in the extremities, and muscle spasms (cramps) after dialysis. The initial mean pain intensity score on the Visual Analog Scale (VAS) was 5.5 (range 3-8). Inclusion and Exclusion Criteria: Patients were included if they were on hemodialysis for at least 4 years and experienced pain. Patients with acute pain conditions or those taking other analgesics were excluded. Ethical Considerations: The study was conducted in accordance with the Helsinki Declaration, and ethical approval was obtained from the Institutional Review Board (IRB) of Tashkent Pediatric Medical Institute (Approval No.13 – 03.07.2024 year). Treatment: Patients received acetaminophen in a dose of 500 mg orally as needed, 3–4 times a day. The total daily dose did not exceed 2 g/day. The treatment course lasted up to 2 weeks. Outcome Assessment: Pain intensity was measured using the VAS before and after acetaminophen administration. Quality of life was assessed using the SF-36 scale before starting therapy and after the treatment course. Kidney function was monitored every two weeks, including glomerular filtration rate (GFR), urea levels, and creatinine levels.
Results:
Statistical Analysis: Data were analyzed using Microsoft Excel. A paired t-test was used to compare pre- and post-treatment VAS scores, with a significance level set at p<0.05.
Results: Following the acetaminophen treatment, the results were as follows: 40% of patients reported significant pain reduction on the VAS, down to 2 ± 1 (p=0.05). 50% of patients experienced slight pain reduction, down to 3 on the VAS (p=0.05). 10% of patients noted no change in pain intensity (p=0.05). The SF-36 scale showed an improvement in quality of life, particularly in the domains of physical functioning and bodily pain (p=0.05). Monitoring of kidney function indicated that GFR, urea levels, and creatinine levels remained stable throughout the study period, with no significant changes observed (p=0.05). Study Limitations: Due to the short duration of the treatment course, the study was unable to assess long-term side effects of paracetamol. Additionally, the relatively small sample size and lack of a control group limit the generalizability of the findings. Further research is needed to determine the potential long-term risks and complications associated with prolonged use of the medication in stage 5 CKD patients.
Conclusions:
Conclusion: Acetaminophen administered at a dose of 500 mg 3–4 times a day proved to be an effective and safe pain relief option for patients with stage 5 CKD on chronic hemodialysis in the short term. The majority of patients experienced pain reduction, which contributed to improved quality of life, with no significant changes in kidney function observed. However, additional studies are required to evaluate the long-term safety of acetaminophen, particularly with larger sample sizes and over extended periods of time.
Clinical Implications: The study suggests that acetaminophen can be safely used for short-term pain management in stage 5 CKD patients on hemodialysis. Clinicians should monitor kidney function regularly during treatment and consider the cumulative effects of long-term use. Future research should focus on establishing long-term safety profiles and exploring alternative analgesic options for this vulnerable population.
Funding and Conflicts of Interest: This study was supported by KOICA. The authors declare no conflicts of interest. This research was supported by the Korea International Cooperation Agency (KOICA) grant funded by the Korean government
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.