MO843: Prevalence of Knee Pain in Maintenance Hemodialysis Patients and its Relation to Quality of Life, Depression and Anxiety
Authors: Nagy Eman , Mohammed Elsayed Abdelrahman , Kamal Nassar Mohammed , Tharwat Samar 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Maintenance hemodialysis (MHD) patients have higher morbidity and mortality compared with general population. Musculoskeletal symptoms causing chronic pain are prevalent among them. Knee pain is one of these symptoms, which may lead to impaired physical ability and health-related quality of life (HRQOL) as well as it may afflict mental state of these patients. Thus, the aims of the current study are to assess prevalence of knee pain, and its relation to HRQOL, anxiety and depression in MHD patients.

METHOD
This cross-sectional multi-centric study was conducted on 271 patients who had been on hemodialysis (HD) for &gt;6 months. These patients were recruited from multiple HD centers in two governorates in Egypt from June to December 2021. Socioeconomic, clinical and laboratory data were obtained from the patients. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to evaluate knee pain [1]. Mood disorders in the form of anxiety and depression were assessed by the hospital anxiety and depression scale (HADS). Kidney Disease Quality of Life (KDQOLTM-36) was used to measure HRQOL of these patients. The studied patients were divided into 2 groups according to the presence of knee pain. The severity of knee pain was defined by visual analogue scale as follows: mild (1–3), moderate (4–6) and sever (7–10). Comparison between two groups of patients was carried out as regards socioeconomic, clinical and laboratory data, anxiety, depression and 5 components of HRQOL.

RESULTS
The present study involved 271 (160 males). The median age of the patients was 51 years with median duration of HD of 6 years. Knee pain was present in 158 patients (58.3%). Patients with knee pain were significantly older than those without (P = 0.013). Females (50% versus 28.3%), patients who not had a job (34.8% vas 26.5%) and patients with psychiatric disorders (5.7% versus 0) constituted significantly higher percentages in group of patients with knee pain than other group. On the other hand, there were no statistically significant differences between both groups regarding marital status, residence, educational level, socioeconomic status and smoking. HD duration was significantly longer in patients with knee pain than those without (P = 0.004). Patients with knee pain had significantly lower blood hemoglobin than without (10.26 ± 1.3 versus 10.67 ± 1.3, P = 0.02). Median and min-max of WOMAC scores were 34.4(0–36), 55.2(12–78 and 53.1(4–100) in mild, moderate, and sever knee pain, respectively. Patients with abnormal anxiety score were significantly more in group of patients with knee pain than those without (P = 0.002). Four components of HRQOL were significantly worse MHD patients with knee pain (Table 1).

CONCLUSION
Knee pain is prevalent among MHD patients. Older age, female gender, longer duration of hemodialysis, and psychiatric disorders are risk factors that may contribute to knee pain. Knee pain in MHD patients is associated with impaired HRQOL and anxiety. Pain, stiffness and physical function are worsening with increased severity of knee pain among these patients.