KHA-CARI Autosomal Dominant Kidney Disease Guideline: Management of Chronic Pain
Section snippets
Ungraded Suggestions for Clinical Care
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An initial assessment (detailed history, psychosocial assessment, and physical examination) should be performed to determine the most likely basis of chronic pain in patients with autosomal dominant polycystic kidney disease (ADPKD). The initial evaluation should attempt to distinguish between acute pathology (often due to cyst infection, stones, or bleeding) and chronic pathology (caused by cyst expansion or mechanical back pain from increased kidney mass). Thus, pain due to cyst infection is
Implementation and Audit
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Assessment of chronic renal pain in patients with ADPKD attending renal clinics.
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A quality-of-life survey asking patients with ADPKD about pain control.
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Use of magnetic resonance imaging to determine whether pain is due to cyst bleeding, infection or enlargement, or to mechanical back pain.
Background
Pain is very common in ADPKD, occurring in up to 60% of patients at some time.2, 3 Renal pain is found in 40% of dialysis patients with ADPKD but only in 2% with other diseases (P = .0001).4 Seven percent of patients with ADPKD reported taking pain medication within 1 month of evaluation and these individuals had a lower score on the physical well-being component of the Short Form 36 questionnaire.5
Pain may be short-lived, or long-term and disabling. It is most often located in the lower back,
Databases Searched
Medical Subject Headings (MeSH) terms and text words for autosomal dominant polycystic kidney disease were combined with the MeSH terms and text words for chronic pain. This was then combined with further searches using the MeSH and text words for pain relief, nonpharmacological interventions, and pharmacological interventions. Animal studies were specifically excluded. The search was carried out in Ovid MEDLINE (1946 to June 2014), Embase (1974 to May 23, 2014), PsycINFO (1806 to June 2014),
What is the evidence?
Supplementary evidence Tables are available online.
Summary of the Evidence
Pain from polycystic kidneys can be caused by cyst infection, bleeding, or stone disease. Chronic pain is usually related to increased cyst size and mechanical back pain due to increased kidney or liver volume. Currently, there is limited evidence for nonpharmacological, pharmacological, or surgical interventions, and the optimal management of chronic pain in patients with ADPKD is not known. Studies conducted so far have been limited by small sample size and heterogeneity of inclusion
What do the other guidelines say?
Kidney Disease Outcomes Quality Initiative: No recommendation.
UK Renal Association: No recommendation.
Canadian Society of Nephrology: No recommendation.
European Best Practice Guidelines: No recommendation.
International Guidelines: No recommendation
Suggestions for Future Research
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Determination of the incidence and prevalence of pain in patients with ADPKD.
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Assessment of the effectiveness and best method of delivering various nonpharmacological approaches in the management of chronic pain in patients with ADPKD.
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Determination of the clinical and radiological risk factors for developing pain due to enlarged renal cysts. The clinical utility of monitoring kidney cyst size using imaging in patients with ADPKD.
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Inclusion of an assessment of chronic pain, as a patient-related
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J Urol
(2012)
Laparoscopic cyst marsupialization in patients with autosomal dominant polycystic kidney disease
J Urol
Chronic kidney pain in autosomal dominant polycystic kidney disease: a case report of successful treatment by catheter-based renal denervation
Am J Kidney Dis
Thoracoscopic renal denervation for intractable autosomal dominant polycystic kidney disease-related pain
Am J Kidney Dis
Evaluation and management of pain in autosomal dominant polycystic kidney disease
Adv Chronic Kidney Dis
Cited by (0)
Financial support: KHA-CARI Guidelines is supported by Kidney Health Australia, the Australian and New Zealand Society of Nephrology, Amgen Australia, and Shire Australia Pty Ltd. Guideline members were not remunerated for their work.
Conflict of interest statement: Judy Savige is a board member of the Alport foundation of Australia, a nonprofit organization; and Gopala Rangan is a member of the Advisory Committee on the Safety of Medical Devices and received financial support to attend the KDIGO Controversies Conference on ADPKD in 2014.