Prevalence and Management of Chronic Pain, Including Neuropathic Pain, in Dialysis Patients with End-Stage Renal Disease.

BACKGROUND Chronic kidney disease (CKD) is a growing global health concern. Chronic pain, as a common symptom of CKD, particularly among patients with end-stage renal disease (ESRD), is influenced by complications, dialysis procedures, and comorbidities. We aimed to evaluate chronic pain and probable neuropathic pain in 96 dialysis patients with ESRD using the Douleur Neuropathique 4 (DN4) questionnaire. MATERIAL AND METHODS A total of 96 patients from a single dialysis center were enrolled for the purpose of this study. ESRD was caused by diseases causing kidney damage, such as diabetes. The average duration of maintenance dialysis was 4.6±5.67 years. Comorbidities, functional and mental assessment, and pharmacological treatment data were collected using a questionnaire. The satisfaction with life scale was also used. Chronic pain was defined as lasting more than 3 months. The DN4 was used to determine the neuropathic component of pain. RESULTS Chronic pain was observed in 63.5% of the study participants, with 47.5% of them reporting the presence of neuropathic pain accompanied by a neuropathic component. Significantly more patients with chronic pain reported mood disorders and reduced life satisfaction, but there was no difference in their activities of daily living-assessed functional status or duration of dialysis. Patients experiencing chronic pain received non-steroidal anti-inflammatory drugs, paracetamol, and opioids. CONCLUSIONS Chronic pain, especially with a neuropathic component, is highly prevalent in patients with CKD, and its treatment remains ineffective. Undiagnosed components of pain can contribute to underdiagnosis and inadequate therapy. Further studies and staff education are needed to address this important issue.

Access to selected diagnostic procedures in the management of heart failure patients in Poland - POLKARD 2005.

BACKGROUND: Polish heart failure surveys from 1999 and 2005 indicated that non-invasive and invasive diagnostic procedures in heart failure patients are underused, mostly due to limited availability. AIM: To assess the access to procedures used for the diagnosis and treatment of heart failure in randomly selected outpatient clinics and hospital wards in Poland. METHODS: The study was undertaken in 2005, as a part of the National Project of Prevention and Treatment of Cardiovascular Diseases - POLKARD. The data on non-interventional and interventional procedures were collected from 400 primary care units, 396 secondary outpatient clinics and 259 hospitals, and included cardiology or internal medicine departments. Additionally, the last five patients with diagnosed heart failures were identified, who visited outpatient clinics or were discharged from the hospitals, and their medical records of diagnostic procedures were analysed. RESULTS: Echocardiography was not available in approximately 10% of hospital wards and 13-37% of outpatient clinics, both primary and secondary. Generally, the waiting time for echocardiography in Poland varied from region to region. A one-month waiting time was declared by more than 50% of secondary outpatient clinics and only 11-18% of primary care units, regardless of the community size. On the first day of hospital admission, echocardiography was performed in approximately 10% of patients of internal medicine wards and up to 36% of patients in cardiology departments. The assessment of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) was generally performed only in a few hospitals, usually in cardiology departments. In primary care units, it was practically not available. Percutaneous coronary interventions, pacemaker or cardioverter-defibrillator implantations were available in approximately 20% of city hospitals, 30-40% of province hospitals, and 60-70% of clinical wards of medical universities. CONCLUSIONS: These data show limited availability of echocardiography in primary care units. It is necessary to continue actions for better accessibility and frequency of performing interventional procedures in patients with heart failure in Poland.

Heart failure management in Poland: The National Cardiovascular Disease Prevention and Treatment Program POLKARD, edition 2003-2005.

BACKGROUND: The aim of this study was to assess actual management of heart failure (HF) in Poland, both in outpatient clinics and hospitals. METHODS AND RESULTS: The survey was undertaken between April 21 2005 and December 31 2005 in 796 outpatient departments and 258 internal medicine and cardiology hospital wards chosen at random. In total 3980 HF outpatients and 1294 inpatients were included. Trained nurses performed the questionnaire-based assessment of diagnostic procedures and pharmacotherapy. Heart failure was diagnosed among general practitioners' (GPs) outpatients most frequently, basing on symptoms (64.0%), ECG (47.0%) and chest X-ray (29.9%), while specialists based their diagnosis on symptoms (52.2%) and echocardiography (37.7%). Most HF outpatients and hospital patients were treated with ACE-I (88.3% and 81%, respectively), beta-blockers (68.3% vs. 84.7%) and diuretics (74.4% vs. 90.3%). Spironolactone accounted for 48.3% vs. 56.3% of the patients, while digitalis glycosides 39.2% and 27.4%, respectively. AT-1 blockers were used very rarely (3.5% vs. 2.5%). CONCLUSIONS: GPs in Poland tend to diagnose HF on clinical grounds while specialists use more diagnostic investigations. Specialists provide higher quality HF care than GPs, both in outpatient clinics and hospitals. Significant progress in HF management has occurred in Poland since previous studies. (Cardiol J 2007; 14: 552-560).