Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Subject Collections
    • Archives
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • Editorial Team
  • Subscriptions
  • More
    • Advertising
    • Reprint Information
    • Impact Factor
    • About CJASN
    • Feedback
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • In the Loop
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • In the Loop
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Subject Collections
    • Archives
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • Editorial Team
  • Subscriptions
  • More
    • Advertising
    • Reprint Information
    • Impact Factor
    • About CJASN
    • Feedback
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
Clinical Nephrology
You have accessRestricted Access

Pain, Sleep Disturbance, and Quality of Life in Patients with Chronic Kidney Disease

Scott D. Cohen, Samir S. Patel, Prashant Khetpal, Rolf A. Peterson and Paul L. Kimmel
CJASN September 2007, 2 (5) 919-925; DOI: https://doi.org/10.2215/CJN.00820207
Scott D. Cohen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Samir S. Patel
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Prashant Khetpal
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rolf A. Peterson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paul L. Kimmel
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background and Objectives: Few studies have assessed sleep disturbances or perception of pain in patients with early-stage chronic kidney disease. It was hypothesized that perception of pain and sleep disturbance would increase with chronic kidney disease stage, that pain and sleep disturbance would correlate with psychosocial variables, and that there would be a higher prevalence of pain and sleep disturbances in patients with chronic kidney disease compared with general medical patients.

Design, Setting, Participants, & Measurements: A total of 92 predialysis patients with chronic kidney disease and 61 general medical outpatients were evaluated using the Beck Depression Inventory, Illness Effects Questionnaire, Multidimensional Scale of Perceived Social Support, Satisfaction with Life Scale, Karnofsky Scale, Pittsburgh Sleep Questionnaire, and McGill Pain questionnaire.

Results: With the exception of expected differences in serum creatinine, estimated GFR, Karnofsky score, albumin, and hemoglobin, there were no significant differences between groups. A total of 69% of patients with chronic kidney disease experienced pain; 55.2% had disordered sleep. Pain was associated with quality-of-life indicators, including depression, burden of illness, and life satisfaction. Disordered sleep correlated with depression, illness burden, social support, and pain frequency. There were no differences in perception of pain or sleep disturbance between patients with chronic kidney disease and control patients.

Conclusions: Pain is common in patients with early-stage chronic kidney disease and is associated with patients’ perception of lower quality of life. The prevalence of pain, sleep disturbance, and abnormal psychologic status of patients with chronic kidney disease may be similar to outpatients with other chronic medical illnesses.

Sleep disorders are prevalent in patients with ESRD (1–5). They are not necessarily improved by dialysis but may be ameliorated by transplantation (6,7). Perception of pain was recently identified as an important symptom in patients with ESRD (8–10). Both perception of pain and sleep disturbance may have a large impact on quality of life (QOL) for patients with ESRD (10,11).

Many studies have shown the QOL of dialysis patients to be lower than that in the general population (11–15). QOL may affect mortality in a variety of conditions, including ESRD (13–21). McClellan et al. (20) demonstrated that functional status and QOL predict early mortality among patients who enter treatment for ESRD. DeOreo (21) showed that functional status was associated with mortality and frequency of hospitalizations. The Dialysis Outcomes and Practice Patterns Study (DOPPS), a large, international, observational study, demonstrated that QOL indicators from the SF-36 were associated with differential survival and morbidity (18).

Pain and sleep disturbances have been shown to affect QOL in a variety of medical conditions (22,23). Perception of sleep disturbances and depression have been correlated in several general population studies (24–30). Kaneita et al. (24) recently studied this relationship in Japan and collected data on depression and sleep disturbances from 24,686 individuals. They found an inverse relationship between depression and perception of sleep disturbance (24). Furthermore, sleep disturbances have been associated with common medical illnesses, including cerebrovascular and coronary artery disease (31). Perception of pain is believed to have a significant effect on sleep disturbance in patients with arthritis and other general medical conditions (32).

Few studies have assessed sleep disturbances or perception of pain in patients with early-stage chronic kidney disease (CKD). Studies have been hampered by lack of non–kidney disease control populations. Associations between psychologic status, perception of QOL, disturbed sleep, and pain have not been evaluated in patients with early stages of CKD.

The purpose of this study was to evaluate the association of perception of sleep disturbance and pain with QOL indicators such as depression and perception of burden of illness in outpatients with CKD. Our hypothesis was that perception of pain and sleep disturbance would worsen on the basis of stage of CKD and that perception of pain and sleep disturbance would correlate with psychosocial variables, including depressive affect and burden of illness scores.

Materials and Methods

The site of the study was the George Washington University Medical Center (GWUMC) Outpatient Clinic. All patients with CKD in the GWUMC outpatient clinic were eligible to participate. The control group consisted of general medicine outpatients without CKD. A serum creatinine of <1.5 mg/dl was used to enroll patients in the control arm of the study. The study was approved by the Committee on Human Research of the GWUMC. Data were collected by research assistants who administered questions in an interview format. Informed consent was obtained. Eligible patients were not selected consecutively. Clinics and patients were targeted for recruitment on the basis of research assistant availability and diagnostic screening from clinic schedules. We used the Beck Depression Inventory (BDI), Illness Effects Questionnaire (IEQ), Single Question QOL Scale (SQQOL), Multidimensional Scale of Perceived Social Support (MSP), Satisfaction with Life Scale (SWLS), Karnofsky scores, Pittsburgh Sleep Questionnaire (PSQ), and a modified McGill Pain Questionnaire to evaluate participants. We also measured treatment and nutrition parameters, including albumin, hemoglobin, and estimated GFR (eGFR) using the Modification of Diet in Renal Disease (MDRD) Equation (33). Ethnicity was determined by patient self-report.

Measures

BDI.

The BDI is a screening tool for depression that has been used in both the general and CKD populations. It consists of 21 items that examine somatic and cognitive effects of depression, using a rating scale to quantify the level of depression as none, mild, moderate, or severe (34,35). Each question is scored from 0 to 3. In the general population, a BDI score of ≥11 is used as a cutoff for depression (34). Scores of ≥11 are indicative of depression in the general population, whereas scores >14 are used as cutoff values in patients with ESRD (35,36). BDI scores have been linked with mortality in patients with ESRD (13,37).

IEQ.

The IEQ is used to quantify the patient's perception of burden of illness. It contains 20 items scored on a seven-point Likert scale. The IEQ has been validated in ESRD and CKD patient populations and has also been associated with mortality (11,15,16,37–40).

SQQOL.

The SQQOL has been used in several recent studies of dialysis patients (10,11). We showed that this single-question global QOL measure correlated with depression, number of symptoms, life satisfaction scores, perception of burden of illness, social support, and satisfaction with nephrologist scores but not with age, level of albumin, hemoglobin, Kt/V, or Karnofsky scores, demonstrating its validity as a QOL measure (10,11).

MSP.

The MSP consists of 12 questions on a seven-point scale designed to measure overall perceived social support from family, friends, or significant others (41,42). The scale has previously been used in patients with CKD (13,16,38–40). Higher scores are associated with improved survival in patients who have ESRD and are treated with hemodialysis (16).

SWLS.

The SWLS contains five items, rated on a scale from 1 to 7, that are designed to measure overall perception of QOL (43,44). The SWLS has been shown to correlate with a number of subjective QOL measures (43). The SWLS has also been validated in ESRD and CKD populations (11,15,16,37,38).

The Karnofsky Performance Status Scale (45).

The Karnofsky Performance Status Scale measures a patient's functional status using a scale that ranges from 0 to 100. A score of 100 signifies full capacity to carry out normal activities of daily living, and a score of 0 indicates death. Scores <70 indicate that some level of assistance is needed to carry out daily activities. The Karnofsky scale has been used in previous QOL studies in patients with ESRD and CKD (11,13,15,16,38).

PSQ.

The PSQ screens for sleep disturbances during a 1-mo period (46). There are 19 questions with seven “component” scores including “subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction” (46). The seven component scores are summed to give one global score (46). A global Pittsburgh Sleep Quality Index (PSQI) score >5 has an 89.6% sensitivity and 86.5% specificity for determining disturbance in sleep (46). The PSQ has previously been used in both patients with ESRD and CKD (47,48).

McGill Pain Questionnaire.

A modified McGill Pain Questionnaire was used to measure perception of pain. This survey includes questions regarding the nature, location, frequency, intensity, and duration of pain (49). It has previously been used in patients with ESRD (9,10,50). Pain frequency was measured by asking patients how often they experience pain on a scale from 1 to 10, with 1 defining rarely experiencing pain and 10 defining always experiencing pain. Pain duration was measured by asking patients how long their pain lasts in minutes. The intensity of pain was rated on an intensity scale of 1 to 10 (49). The percentage of patients with pain was calculated on the basis of how many patients reported experiencing pain in the past month.

Statistical Analyses

All statistical analyses were performed using SAS version 9.1 (SAS Institute, Cary, NC). Correlation analysis with Pearson or Spearman coefficients was used to assess relationships among the demographic, pain, and sleep variables as appropriate. The Mantel-Haenszel χ2 test was used for comparisons between nominal variables. Duncan multiple range test was used to calculate statistical differences between means of variables. P < 0.05 was considered significant for all tests. Results are expressed as means ± SD.

Results

A total of 120 patients with CKD were approached, and 28 declined, for a total of 92 patients with CKD, or a recruitment rate of 76.7%. A total of 98 general medical patients were approached, and 37 declined, for a total of 61 general medical patients, or a recruitment rate of 62.2%. Table 1 shows the demographic and clinical characteristics of the patients in the CKD and general medical outpatient groups. With the exception of eGFR, serum creatinine, albumin, hemoglobin, and Karnofsky scores, there were no statistically significant differences in mean parameters assessed between the two groups. In the CKD group, 73.9% were black and 48.3% of patients were female. The mean age was 62.4 ± 12.5 yr; 46.1% had diabetes. The mean Karnofsky score was 82.5 ± 13.6. Mean serum creatinine concentration was 2.8 ± 1.9 mg/dl, with a mean eGFR of 33.4 ± 23.7 ml/min per 1.73 m2. The mean serum albumin concentration was 4.0 ± 0.5 g/dl, and mean hemoglobin concentration was 11.9 ± 1.7 g/dl. The mean IEQ score was 41.6 ± 29.8, and mean BDI score was 7.4 ± 6.9. Mean total MSP score was 69.0 ± 15.8, with a mean SWLS score of 23.0 ± 8.5. The MSP and SWLS scores are similar to that of normative populations (16). The mean SQQOL score was 7.4 ± 2.3. There were no statistically significant differences in the psychologic, pain, or sleep variables between the two groups, as shown in Table 2.

View this table:
  • View inline
  • View popup
Table 1.

Comparison of demographic and clinical characteristics of the CKD and general medical groupsa

View this table:
  • View inline
  • View popup
Table 2.

Psychological, pain, and sleep variables in general medical patients and patients with CKDa

Sixty-nine percent of patients with CKD experienced pain, with a mean pain intensity score of 4.5 ± 3.7. Fifty-five percent of patients with CKD had disordered sleep, with a mean PSQ score of 6.8 ± 3.9. The proportion of patients who experienced pain or disordered sleep was not different in the CKD or the general medical patient groups. There was no correlation of pain and sleep parameters with GFR or stage of CKD (Figures 1 and 2, Tables 3 and 4). There was also no significant difference in the mean psychologic, pain, and sleep variables across the various stages of CKD (Table 5).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Percentage of patients who reported pain in the past month. CKD, chronic kidney disease.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

Percentage of patients with a sleep disturbance (Pittsburgh Sleep Questionnaire score >5).

View this table:
  • View inline
  • View popup
Table 3.

Correlation matrix of psychosocial, pain, sleep, medical and demographic variables in the CKD groupa

View this table:
  • View inline
  • View popup
Table 4.

Correlation matrix of psychosocial, pain, and sleep variables in CKDa

View this table:
  • View inline
  • View popup
Table 5.

Mean demographic, psychosocial, pain, and sleep variables in CKD

Table 3 displays a correlation matrix of demographic; medical and treatment variables; and psychosocial, pain, and sleep variables in patients with CKD. Table 3 is notable for the lack of statistically significant correlations between these variables. Hemoglobin level correlated with BDI and MSP scores, whereas Karnofsky scores correlated with IEQ, SQQOL, SWLS, and pain frequency measures. In contrast, Table 4 is notable for the numerous significant intercorrelations between the psychosocial, pain, and sleep variables. Pain intensity correlated with depressive affect (BDI; r = 0.278, P = 0.010), perceived burden of illness (IEQ; r = 0.297, P = 0.006), social support (MSP; r = −0.241, P = 0.026), and satisfaction with life (SWLS; r = −0.221, P = 0.046) measures. Pain frequency was associated with all QOL indicators: Depressive affect (BDI; (r = 0.295, P = 0.006), perceived burden of illness (IEQ; r = 0.326, P = 0.002), social support (MSP; r = −0.217, P = 0.045), and satisfaction with life (SWLS; r = −0.254, P = 0.020) measures, as well as the SQQOL (r = −0.271, P = 0.011). Total PSQ scores correlated with depressive affect (BDI; r = 0.220, P = 0.047), perceived burden of illness (IEQ; r = 0.324, P = 0.003), social support (MSP; r = −0.286, P = 0.009), SQQOL (r = −0.217, P = 0.045), and pain frequency (r = 0.247, P = 0.023).

Discussion

Patients with CKD frequently perceive pain and sleep disturbances. In this study, perception of pain and sleep disturbances of patients with CKD was not associated with demographic or treatment variables; neither was perception of pain and sleep disturbances associated with creatinine, CKD stage, or eGFR. Perception of poor sleep of patients with CKD is tightly linked to poorer QOL, defined by many measures, as well as their perception of pain (as in hemodialysis patients) (5,8,9,11,14,15). Counterintuitively, there were no significant differences in mean perception of pain or sleep disturbance between the patients with CKD and a comparison population of 61 general medical outpatients without renal disease.

Few studies have evaluated perception of pain and sleep disturbance in patients with early-stage CKD. Ilieuscu et al. (47) studied the prevalence of sleep disturbance in patients who had CKD and did not yet require renal replacement therapy. Using the PSQI as a measure of perception of disturbed sleep, they reported that 63 of 120 patients (57.5%) had poor sleep, as defined by a global PSQI score of >5 (47). There was no association between the global PSQI score and blood urea nitrogen, serum creatinine, or calculated creatinine clearance, similar to our findings (47). De Santo et al. (51) evaluated the prevalence of sleep disorders in 52 patients with early stages of CKD using a 26-item self-administered questionnaire. They found an 80.7% prevalence of sleep disturbance in patients with early stages of CKD (51). However, there was no control population in these studies (47,51).

Kurella et al. (52) found a high prevalence of sleep disturbances in patients with CKD and ESRD using the Kidney Disease Quality of Life (KDQOL) sleep scale. However, in contrast to our study, they found a direct association between eGFR and scores on the KDQOL sleep scale in nonblack patients. Potential reasons for the disparities in results would include the use of different instruments, size of studies, sample population, and study design used (52).

The prevalence of pain, sleep disturbance, and abnormal psychosocial status of patients with CKD may be similar to that of outpatients with diabetes and other chronic medical illnesses. It is unclear why these results are similar between the two groups. One possibility is that the average GFR, 33.4 ± 23.7 ml/min per 1.73 m2 in the CKD group, was not decreased to the level where uremic symptoms would be expected. In addition, it is possible that although the patients with CKD have more severe disease burden, they may be more likely to deny the severity of their illness as a coping mechanism.

Shidler et al. (38) discussed this possibility in a study of 50 patients with chronic renal insufficiency in which the relationship between QOL and psychosocial parameters was explored. A dissociation between stage of disease and social support was noted in this study, suggesting the possibility of denial. Similar to the results of our study that showed comparable results between patients with CKD and general medical patients, Shidler et al. (38) did not find a correlation between decreased renal function and psychologic measures, including the IEQ, BDI, and SWLS.

It is also possible that the general medical population had a high degree of chronic medical illness, including diabetes and osteoarthritis, which could have led to the similarity in these results. There were, however, no differences between the proportion of patients with diabetes in the CKD and general medical groups. There is likely a high prevalence of psychologic illness in the general medicine clinic patients, which may be similar to the prevalence of psychologic illness in the CKD group (53). Psychologic illness may be associated with perception of pain and sleep disturbance (48). A potential limitation of the study, in addition to the difference between groups in the Karnofsky score, is the absence of assessment of Charlson comorbidity scores, which may have differed between the groups. Previous studies have shown a high prevalence of sleep disturbance in the general population, further supporting these similar results between the CKD and general medical groups. Morin et al. (54) evaluated the prevalence of insomnia in 2001 adults from Quebec, Canada. Approximately one quarter of the patients surveyed reported disordered sleep (54), similar to the CKD population in this study, supporting our results that show a high prevalence of sleep disturbance in both groups. The reasons for these similarities are not entirely clear, but delineation of differences between these populations will require larger and multicenter sampling strategies.

Other potential limitations of this study include its cross-sectional nature. Therefore, direction and causality cannot be inferred. In addition, the patient selection cannot be viewed as a random process. However, we do not know of a particular bias that could be introduced into the study because of our approach, because we surveyed the renal and the general medical patients in a similar manner. Consideration must be given to the fact that in correlational analyses, multiple comparisons may render associations with P values between 0.01 and 0.05 potentially relatively less meaningful. Correlations with r values of <0.3 suggest relationships in which <10% of the variation in a parameter is explained by the change in the magnitude of the other factor. Nevertheless, this study provides potentially important information. This is the only controlled data on QOL and symptoms in early-stage CKD to our knowledge. In addition, the CKD and control groups that were recruited were well matched for all variables, with the expected exception of serum creatinine, eGFR, hemoglobin, and Karnofsky score.

Conclusions

Our data showing strong relationships between pain, sleep disturbances, and psychologic variables suggest that interventions directed at the symptoms of pain and disordered sleep may improve the psychological status of patients with CKD. Alternatively, psychosocial interventions such as treatment of depression or interventions designed to increase social support may improve perception of pain and sleep disorders in patients with CKD. Nephrologists should be aware of the prevalence of pain and perception of disturbed sleep in patients and should consider screening patients for these symptoms.

Disclosures

None.

Acknowledgments

S.D.C. was supported by a research fellowship from the National Kidney Foundation. We thank the patients for participating in this study. We also thank the faculty members of the Divisions of Renal Diseases and Hypertension and General Internal Medicine for their help in patient recruitment.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • Received February 14, 2007.
  • Accepted May 25, 2007.
  • Copyright © 2007 by the American Society of Nephrology

References

  1. ↵
    Millman RP, Kimmel PL, Shore ET, Wasserstein AG: Sleep apnea in hemodialysis patients: The lack of testosterone effect on its pathogenesis. Nephron40 :407– 410,1985
    OpenUrlPubMed
  2. Kimmel PL, Miller G, Mendelson WB: Sleep apnea syndrome in chronic renal disease. Am J Med86 :308– 314,1989
    OpenUrlCrossRefPubMed
  3. Zoccali C, Mallamaci F, Tripepi G: Sleep apnea in renal patients. J Am Soc Nephrol12 :2854– 2859,2001
    OpenUrlFREE Full Text
  4. Hanly P: Sleep apnea and daytime sleepiness in end-stage renal disease. Semin Dial17 :109– 114,2004
    OpenUrlCrossRefPubMed
  5. ↵
    Shayamsunder AK, Patel SS, Jain V, Peterson RA, Kimmel PL: Sleepiness, sleeplessness, and pain in end-stage renal disease: Distressing symptoms for patients. Semin Dial18 :109– 118,2005
    OpenUrlCrossRefPubMed
  6. ↵
    Langevin B, Fouque D, Leger P, Robert D: Sleep apnea syndrome and end-stage renal disease. Cure after renal transplantation. Chest103 :1330– 1335,1993
    OpenUrlCrossRefPubMed
  7. ↵
    Auckley DH, Schmidt-Nowara W, Brown LK: Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation. Am J Kidney Dis34 :739– 744,1999
    OpenUrlPubMed
  8. ↵
    Shayamsunder AK, Anekwe E, Khetpal P, et al. Sleep disturbance, pain and quality of life in hemodialysis patients [Abstract]. J Am Soc Nephrol15 :636A– 637A,2004
    OpenUrl
  9. ↵
    Davison SN. Pain in hemodialysis patients: Prevalence, cause, severity, and management. Am J Kidney Dis42 :1239– 1247,2003
    OpenUrlCrossRefPubMed
  10. ↵
    Kimmel PL, Elmont SL, Newman JM, Danko H, Moss AH: ESRD patient quality of life: Symptoms, spiritual beliefs, psychosocial factors, and ethnicity. Am J Kidney Dis42 :713– 721,2003
    OpenUrlCrossRefPubMed
  11. ↵
    Patel SS, Kimmel PL: Quality of life in patients with chronic kidney disease: Focus on end-stage renal disease treated with hemodialysis. Semin Nephrol26 :68– 79,2005
    OpenUrlCrossRef
  12. Evans RW, Manninen DL, Garrison LP, Hart LG, Blagg CR, Gutman RA, Hull AR, Lowrie EG: The quality of life of patients with end-stage renal disease. N Engl J Med312 :553– 559,1985
    OpenUrlCrossRefPubMed
  13. ↵
    Kimmel PL: Psychosocial factors in dialysis patients. Kidney Int59 :1599– 1613,2001
    OpenUrlCrossRefPubMed
  14. ↵
    Valderrabano F, Jofre R, Lopez-Gomez JM: Quality of life in end-stage renal disease patients. Am J Kidney Dis38 :443– 464,2001
    OpenUrlPubMed
  15. ↵
    Unruh M, Weisbord SD, Kimmel PL: Health-related quality of life in nephrology research and clinical practice. Semin Dial18 :82– 90,2005
    OpenUrlCrossRefPubMed
  16. ↵
    Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, Veis JH: Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int54 :245– 254,1998
    OpenUrlPubMed
  17. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH: Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol12 :2797– 2806,2001
    OpenUrlAbstract/FREE Full Text
  18. ↵
    Mapes DL, Lopes AA, Satayathum S, McCullough KP, Goodkin DA, Locatelli F, Fukuhara S, Young EW, Kurokawa K, Saito A, Bommer J, Wolfe RA, Held PJ, Port FK: Health-related quality of life as a predictor of mortality and hospitalization. The Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int64 :339– 349,2003
    OpenUrlCrossRefPubMed
  19. Lowrie EG, Curtin RB, LePain N, Schatell D: Medical Outcomes Study Short Form 36: A consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis41 :1286– 1292,2003
    OpenUrlCrossRefPubMed
  20. ↵
    McClellan WM, Anson C, Birkeli K, Tuttle E: Functional status and quality of life: Predictors of early mortality among patients entering treatment for end-stage renal disease. J Clin Epidemiol44 :83– 89,1991
    OpenUrlCrossRefPubMed
  21. ↵
    DeOreo PB: Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization and dialysis attendance compliance. Am J Kidney Dis30 :204– 212,1997
    OpenUrlCrossRefPubMed
  22. ↵
    Skevington SM: Investigating the relationship between pain and discomfort and quality of life, using the WHOQOL. Pain76 :395– 406,1998
    OpenUrlCrossRefPubMed
  23. ↵
    Ancoli-Israel S: The impact and prevalence of chronic insomnia and other sleep disturbances associated with chronic illness. Am J Manag Care12[Suppl] :S221– S229,2006
    OpenUrlPubMed
  24. ↵
    Kaneita Y, Ohida T, Uchiyama M, Takemura S, Kawahara K, Yokoyama E, Miyake T, Harano S, Suzuki K, Fujita T: The relationship between depression and sleep disturbances: A Japanese nationwide general population survey. J Clin Psychiatry67 :196– 203,2006
    OpenUrlPubMed
  25. Ford DE, Kamerow DB: Epidemiological study of sleep disturbances and psychiatric disorders. JAMA262 :1479– 1484,1989
    OpenUrlCrossRefPubMed
  26. Livingston G, Blizard B, Mann A: Does sleep disturbance predict depression in elderly people? A study in inner London. Br J Gen Pract43 :445– 448,1993
    OpenUrlAbstract/FREE Full Text
  27. Breslau N, Roth T, Rosenthal L, Andreski P: Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults. Biol Psychiatry39 :411– 418,1996
    OpenUrlCrossRefPubMed
  28. Chang PP, Ford DE, Mead LA, Cooper-Patrick L, Klag MJ: Insomnia in young men and subsequent depression: The Johns Hopkins Precursors Study. Am J Epidemiol146 :105– 114,1997
    OpenUrlAbstract/FREE Full Text
  29. Roberts RE, Shema SJ, Kaplan GA, Strawbridge WJ: Sleep complaints and depression in an aging cohort: A prospective perspective. Am J Psychiatry157 :81– 88,2000
    OpenUrlPubMed
  30. ↵
    Williams SW, Tell GS, Zheng B, Shumaker S, Rocco MV, Sevick MA: Correlates of sleep behavior among hemodialysis patients: The kidney outcomes prediction and evaluation study (KOPE). Am J Nephrol22 :18– 28,2002
    OpenUrlCrossRefPubMed
  31. ↵
    Elwood P, Hack M, Pickering J, Hughes J, Gallacher J: Sleep disturbance, stroke, and heart disease events: Evidence from the Caerphilly cohort. J Epidemiol Community Health60 :69– 73,2006
    OpenUrlAbstract/FREE Full Text
  32. ↵
    Power JD, Perruccio AV, Badley EM: Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Rheum53 :911– 919,2005
    OpenUrlCrossRefPubMed
  33. ↵
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med130 :461– 470,1999
    OpenUrlCrossRefPubMed
  34. ↵
    Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev8 :77– 100,1988
    OpenUrlCrossRef
  35. ↵
    Craven JL, Rodin GM, Littlefield C: The Beck Depression Inventory as a screen device for major depression in renal dialysis patients. Int J Psychiatry Med18 :365– 374,1988
    OpenUrlPubMed
  36. ↵
    Hedayati SS, Bosworth HB, Kuchibhatla M, Kimmel PL, Szczech LA: The predictive value of self-reported questionnaires compared to physician diagnosis of depression in end-stage renal disease patients receiving chronic hemodialysis. Kidney Int69 :1662– 1669,2006
    OpenUrlCrossRefPubMed
  37. ↵
    Peterson RA, Kimmel PL, Sacks CR, Mesquita ML, Simmens SJ, Reiss D: Depression, perception of illness and mortality in patients with end-stage renal disease. Int J Psychiatry Med21 :343– 354,1991
    OpenUrlCrossRefPubMed
  38. ↵
    Shidler NR, Peterson RA, Kimmel PL: Quality of life and psychosocial relationships in patients with chronic renal insufficiency. Am J Kidney Dis32 :557– 566,1998
    OpenUrlPubMed
  39. Weisbord SD, Fried F, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, Switzer GE: Prevalence, severity, and importance of physical symptoms in chronic hemodialysis patients. J Am Soc Nephrol16 :2487– 2494,2005
    OpenUrlAbstract/FREE Full Text
  40. ↵
    Sacks CR, Peterson RA, Kimmel PL: Perception of illness and depression in chronic renal disease. Am J Kidney Dis15 :31– 39,1990
    OpenUrlPubMed
  41. ↵
    Zimet GD, Dahlem NW, Zimet SG: The multidimensional scale of perceived social support. J Pers Assess52 :30– 41,1988
    OpenUrlCrossRef
  42. ↵
    Dahlem NW, Zimet G, Walker R: The multidimensional scale of perceived social support: A confirmation study. J Clin Psychol47 :756– 761,1991
    OpenUrlCrossRefPubMed
  43. ↵
    Diener E, Emmons RA, Larsen RJ, Griffin S: The satisfaction with life scale. J Pers Assess49 :71– 75,1985
    OpenUrlCrossRefPubMed
  44. ↵
    Pavot W, Diener E: Review of the satisfaction with life scale. Psychol Assess5 :164– 172,1993
    OpenUrlCrossRef
  45. ↵
    Karnofsky DA, Burchenal JH: The Clinical Evaluation of Chemotherapeutic Agents in Cancer. Evaluation of Chemotherapeutic Agents, New York, Columbia University Press,1949
  46. ↵
    Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res28 :193– 213,1989
    OpenUrlCrossRefPubMed
  47. ↵
    Iliescu EA, Yeates KE, Holland DC: Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplant19 :95– 99,2004
    OpenUrlAbstract/FREE Full Text
  48. ↵
    Davison SN, Jhangri GS: The impact of chronic pain on depression, sleep, and the desire to withdraw from dialysis in hemodialysis patients. Pain Symptom Manage30 :465– 473,2005
    OpenUrlCrossRef
  49. ↵
    Melzack R: The McGill Pain Questionnaire: Major properties and scoring methods Pain1 :277– 279,1975
    OpenUrlCrossRefPubMed
  50. ↵
    Barakzoy AS, Moss AH: The efficacy of the world health organization analgesic ladder to treat pain in end-stage renal disease. J Am Soc Nephrol17 :3198– 3203,2006
    OpenUrlAbstract/FREE Full Text
  51. ↵
    De Santo RM, Bartiromo M, Cesare MC, Di Iorio BR: Sleeping disorders in early chronic kidney disease. Semin Nephrol26 :64– 67,2006
    OpenUrlCrossRefPubMed
  52. ↵
    Kurella M, Luan J, Lash J, Chertow GM: Self-assessed sleep quality in chronic kidney disease. Int Urol Nephrol37 :159– 165,2005
    OpenUrlCrossRefPubMed
  53. ↵
    Ormel J, Von Korff M, Ustun TB, Pini S, Korten A, Oldehinkel T: Common mental disorders and disability across cultures: Results from the WHO collaborative study on psychological problems in general health care. JAMA272 :1741– 1748,1994
    OpenUrlCrossRefPubMed
  54. ↵
    Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C: Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med7 :123– 130,2006
    OpenUrlCrossRefPubMed
View Abstract
PreviousNext
Back to top

In this issue

Clinical Journal of the American Society of Nephrology
Vol. 2, Issue 5
September 2007
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article
Thank you for your help in sharing the high-quality science in CJASN.
Enter multiple addresses on separate lines or separate them with commas.
Pain, Sleep Disturbance, and Quality of Life in Patients with Chronic Kidney Disease
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
Citation Tools
Pain, Sleep Disturbance, and Quality of Life in Patients with Chronic Kidney Disease
Scott D. Cohen, Samir S. Patel, Prashant Khetpal, Rolf A. Peterson, Paul L. Kimmel
CJASN Sep 2007, 2 (5) 919-925; DOI: 10.2215/CJN.00820207

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Pain, Sleep Disturbance, and Quality of Life in Patients with Chronic Kidney Disease
Scott D. Cohen, Samir S. Patel, Prashant Khetpal, Rolf A. Peterson, Paul L. Kimmel
CJASN Sep 2007, 2 (5) 919-925; DOI: 10.2215/CJN.00820207
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Disclosures
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

More in this TOC Section

  • Survival and Kidney Outcomes of Children with an Early Diagnosis of Posterior Urethral Valves
  • Association of Acute Increases in Plasma Creatinine after Renin-Angiotensin Blockade with Subsequent Outcomes
  • The Acute Dialysis Orders Objective Structured Clinical Examination (OSCE)
Show more Clinical Nephrology

Cited By...

  • Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure
  • Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients
  • Sleep and Activity in Chronic Kidney Disease: A Longitudinal Study
  • Longitudinal Association of Depressive Symptoms with Rapid Kidney Function Decline and Adverse Clinical Renal Disease Outcomes
  • Scopus (85)
  • Google Scholar

Similar Articles

Related Articles

  • No related articles found.
  • Scopus
  • PubMed
  • Google Scholar

About

  • ASN
  • CJASN
  • ASN Journals
  • ASN Podcasts
  • CJASN Relaunch

Author Information

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • Reuse/Reprint Policy

More information

  • Advertise
  • Subscribe
  • Email Alerts
  • Sections by Topic
  • Password/Email Address Changes

© 2019 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire