Causes of Pain in Renal (Kidney) Failure and Management Tips
Management
Takeaway
Most people with kidney failure experience pain, most often in their bones and muscles. But the pain is usually due to a complication of kidney failure. It may also be due to the type of treatment.
Kidney failure occurs when your kidneys no longer function well enough to meet your body's needs. It is also known as end stage kidney disease (ESKD) or end stage renal disease (ESRD).
About 60% to 70% of people with advanced chronic kidney disease (CKD) experience pain. And just about all people in the hospital with CKD experience pain as a symptom.
This article explores common causes of pain associated with kidney failure.
Acute vs. chronic renal failure
There are two types of renal failure: acute and chronic.
Acute renal failure occurs when the kidneys fail or stop working suddenly. It's common among people receiving treatment in the hospital for other serious health conditions, such as a heart attack or pneumonia.
The damage from acute kidney failure may be reversible, and symptoms such as pain may go away following treatment.
Causes of pain in renal failure
Pain is a common symptom of kidney failure. Some of the causes of pain linked to kidney failure include:
Mineral and bone disorder
Mineral and bone disorder is a common complication of CKD. It is especially common among people who have kidney failure and receive dialysis.
Mineral and bone disorders don't always cause symptoms. But as it progresses, it can cause aching in your bones and joints.
Calcific uremic arteriolopathy
Also known as calciphylaxis, calcific uremic arteriolopathy (CUA) is a rare but serious condition that occurs among people with ESRD. It causes painful lesions to form on the surface of your skin.
CUA is more common among people assigned female at birth who also have other health conditions, such as diabetes and obesity.
Peripheral neuropathy
CKD and ESRD can damage the nerves that travel from your brain and spinal cord to other areas of your body. This condition is known as peripheral neuropathy.
Peripheral neuropathy may trigger changes in sensation, including pins and needles, numbness, and pain in the extremities.
Pericardial diseases
The pericardium is a thin sac filled with fluid that protects your heart, including the roots of the major blood vessels that stem from your heart.
Heart conditions linked to ESRD include:
uremic pericarditis
pericardial effusion
constrictive pericarditis
Each condition causes chest pain that feels worse when you inhale.
Autosomal dominant polycystic kidney disease
Some types of primary kidney disease are associated with increased pain symptoms. In particular, autosomal dominant polycystic kidney disease (ADPKD) is a genetic condition that causes kidney cysts.
Pain is a common symptom. It may be due to:
infected, bleeding, or ruptured kidney cysts
cyst growth
urinary tract infections
kidney stones
Dialysis
Although dialysis is an important treatment, it can also be a source of pain in kidney failure. Some people who undergo dialysis report muscle cramps, bloated abdomen, and pain at the insertion site of the needle.
Underlying diseases
People with kidney failure are more likely to have coexisting health conditions that may cause pain. Some coexisting health conditions that studies have linked to pain in kidney failure include:
diabetic neuropathy
ischemic peripheral artery disease
osteopenia
osteoporosis
How to manage pain with renal failure
There are many options for managing pain associated with renal failure. Usually, the treatment depends on the cause, type, frequency, and intensity.
Talk with your healthcare team if you have pain associated with renal failure. Possible treatments include medication and behavioral and physical therapies.
Medications for pain linked to renal failure include:
acetaminophen
gabapentinoids
some opioids, such as buprenorphine or hydromorphone
serotonin-norepinephrine reuptake inhibitors (SNRIs)
topical analgesics
tricyclic antidepressants
Many of the above medications will require a doctor to adjust the dose, as renal failure can alter the concentration and effect of the drugs. Some opioids, like codeine and morphine, are not safe for people with CKD.
Although research into their effectiveness is limited, other possible treatments for pain linked to renal failure include behavioral and physical interventions, such as:
acupuncture
biofeedback
cognitive behavioral therapy (CBT)
exercise
meditation
physical therapy
yoga
Resources for support
Chronic and untreated pain linked to kidney failure can significantly affect your quality of life. It's also linked to symptoms such as depression and anxiety.
The Centers for Disease Control and Prevention (CDC) provides a list of educational resources for people with CKD.
The National Kidney Foundation offers a list of care providers, services, and educational materials for people living with kidney disease and their families.
The American Kidney Fund offers several financial assistance programs for people who have kidney failure.
Takeaway
Pain is a common symptom among people with ESRD. Although kidney failure doesn't necessarily cause pain, it is associated with several other complications that do.
Pain treatments include medication and behavioral or physical therapy. Your treatment will likely depend on the cause of your pain. A healthcare professional can suggest the best treatment options for you.
You can promote good kidney health with a nutritious diet, getting enough sleep, exercising, and seeking treatment for underlying conditions such as diabetes or high blood pressure.
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'It can be life-changing for their patients, and it works very rapidly, often within 48 hours after the first loading dose.' The Benefits of a Multidisciplinary Approach Research suggests that nephrologists may underestimate the prevalence of pruritus among their patients. This may be due to a lack of communication from their patients. In a study of more than 35,000 patients on dialysis, nearly one fifth had not reported itching to any healthcare provider. Several reasons may account for this reticence, including patients' resilience to symptoms, language ability, lack of time, and assumptions that their provider may not regard itching as a problem. A study including nephrologists, nurses, and patients with CKD found that underreporting and undertreatment of pruritus often stemmed from limited knowledge, ambivalence regarding the importance of itching, and a need for specific prompts during consultation. Physicians should proactively ask patients with CKD and ESRD about itching using validated tools such as the General Itch Questionnaire and the Visual Analog Scale. Additional scales to assess specific domains of pruritus, including sleep impairment and psychological impact, are provided in a paper by Manuel P. Pereira, MD, and colleagues. All the experts interviewed for this article agree on the importance of adopting a multidisciplinary approach in these patients. Dermatologists, nephrologists, nurses, pharmacists, dietitians, and mental health professionals can work together to manage symptoms and improve overall outcomes. Robinson-Bostom, Nori, and Elston declared having no relevant financial relationships. Murase is on the speakers bureau for Regeneron, Genzyme/Sanofi, Galderma, and UCB; advisory boards for Regeneron, Genzyme/Sanofi, UCB, Arcutis, and Bristol Myers Squibb; and consulting for AbbVie, UCB, Sanofi-Regeneron, and UpToDate.
