**3. Definition and staging of chronic kidney disease**

It is very important to identify the degree of IKF and the nature of CKD and on what stage it is, because these factors will guide the management of pain and to some extent predict pain medication pharmacokinetics.

Definition for CKD must have the following criteria:

	- **a.** Pathological abnormalities

**2. Epidemiology**

100 Pain Management in Special Circumstances

severe [2].

common in CKD patients than the general population.

with pain versus 37.7 months for those without pain.

ineffective in 74.8 of patients [5].

medication pharmacokinetics.

patients with a mean age of 82 ± 6.6 years [1].

The prevalence of pain in patients with chronic kidney disease (CKD) has been shown in many epidemiologic studies, and all of them unanimously demonstrate that pain is more

Murtagh et al., in a cross-sectional survey of symptoms prevalence in stage 5 chronic kidney disease managed without dialysis, found that pain was present in 53% (42–63%) of total 66

Davison et al. have analyzed publications from 1992 to 2009 and concluded that 58% of CKD patients are suffering from pain, 49% of those patients rated their pain as moderate to

As quality of life is greatly diminished by any kind of pain, it has been studied in CKD patients as part of symptom burden, for example [3], older patients found musculoskeletal symptoms, including pain in bones/joints (69% of 283 CKD Stage 1–5 patients), are more disturbing and bothersome, while younger patients found that reduced concentration is more intrusive. Perlman et al. also demonstrated that the presence of pain was associated with lower quality-

Additionally, in prospective cohort study of 205 Canadian hemodialysis (HD) patients, 50% of them reported pain which was related to those who was on longer HD therapy, 52.5 months

The etiology of pain was multiple in 18.4% of patients with pain, among which musculoskeletal was the most frequent (50.5%); same study found that almost one third of all patients with pain were not on any painkillers, and authors concluded that pain management was

Pain in CKD patients is an important factor, which immensely affects quality of life. Weisbord et al. showed clear correlation between symptom excess and severity with diminished quality of life. If they had considered pain-related symptoms such as muscle cramps, headache, and

Moreover, CKD patients with pain tend to decide to withdraw from HD more often; as shown by Davison and Jhangri, they also were more depressed and suffered sleep disturbances [7].

It is very important to identify the degree of IKF and the nature of CKD and on what stage it is, because these factors will guide the management of pain and to some extent predict pain

chest pain in pain group, the prevalence would have increased to 50–85% [6].

**3. Definition and staging of chronic kidney disease**

Definition for CKD must have the following criteria:

of-life scores in a multicenter cross-sectional analysis of 634 patients with CKD [4].


Evaluation of kidney function is more dependent on GFR or the presence of other markers of kidney damage rather than a single serum creatinine reading.

Stages of CKD according to GFR are described in **Table 1**.


**Table 1.** Stages of chronic kidney disease according to glomerular filtration rate [8].
