International Variations in Chronic Kidney Disease Patients’ Pain Experience and its Management

Background and Hypothesis Chronic pain significantly impacts health-related quality of life (HRQOL) in patients with non-dialysis chronic kidney disease (ND-CKD), yet the management of pain in this population is challenging. We hypothesized that analgesic prescription practices vary internationally, influencing the pain experience and HRQOL of patients with stage 3–5 ND-CKD. Methods This descriptive, observational, multinational cohort study utilized data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps), enrolling adult patients from nephrology practices in Brazil, France, and the United States between 2013 and 2020. Analgesic prescriptions within six months before HRQOL assessment were categorized as non-steroidal anti-inflammatory drugs (NSAIDs), opioids, or other analgesics. HRQOL was measured using the Kidney Disease Quality of Life Short Form (KDQOL-SF), assessing multiple subdomains. Results Among 3 945 patients, analgesics were most frequently prescribed in the United States across all CKD stages, with opioids prescribed nearly twice as often compared to Brazil and France. NSAIDs are frequently prescribed in Brazil, including in advanced CKD stages, contrasting sharply with practices in France and the US’. Higher reported pain intensity consistently correlated with poorer outcomes across all HRQOL subdomains. Conclusions This study identifies considerable international variability in pain reporting and analgesic prescription patterns in patients with stage 3–5 ND-CKD. Randomized controlled trials evaluating the efficacy and safety of analgesics are warranted to improve key patient-reported outcomes such as pain in patients with ND-CKD.