Dados do Trabalho

Título

Dialysis-related headache: prevalence and clinical features in hemodialysis patients and after kidney transplantation

Resumo

Introduction: Headache is a common symptom, occurring in up to 70% of patients on hemodialysis. Dialysis headache is defined by the International Classification of Headache Disorders (ICHD-3) as a headache with no specific characteristics, occurring during and caused by hemodialysis, and which resolves spontaneously within 72 hours after the session has ended. There is no consensus on its pathophysiology or triggering factors.

Objective: To evaluate the prevalence, clinical features and factors associated with dialysis headache in patients with chronic kidney disease on renal replacement therapy.

Methods: Cross-sectional observational study with a quantitative approach. Participants were divided into two groups: (1) 25 patients on hemodialysis and (2) 25 patients on early post kidney transplantation. All participants were interviewed with a structured questionnaire, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale. Blood pressure, weight, urea, glucose and electrolytes were evaluated before and after one hemodialysis session. Control groups were classified from the headache-free patients in each group.

Results: In group (1), 8 patients (32%) were diagnosed with dialysis headache, predominantly pulsatile (n=6, 75%), accompanied by photophobia (n=6, 75%), phonophobia (n=4, 50%) and nausea or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Individuals with headache had higher scores for anxiety (7.00 ± 3.93 vs. 3.82 ± 3.23, p=0.03) and sleepiness (9.13 ± 3.94 vs. 4.76 ± 3, 85, p=0.01). Dialysis headache was associated with lower pre-dialysis serum calcium (p=0.01), higher pre-dialysis systolic (p=0.02) and diastolic (p=0.02) blood pressure. There was no correlation between headache and variations in serum urea levels. In group (2), 5 patients (20%) were diagnosed with dialysis headache, predominantly pulsatile (n=4, 80%), accompanied by nausea or vomiting (n=4, 80%), aggravated by routine physical activity (n=3, 60%), with a mean pain score of 8 ± 1.41. Individuals with headache had higher sleepiness scores (9.20 ± 4.32 vs. 4.80 ± 4.51, p=0.029) and younger age (38.93 ± 14.43 vs. 54.02 ± 8.31, p=0.03).

Conclusion: Headache is common among patients on hemodialysis, it has migraine-like features, and it is associated with increased anxiety, increased sleepiness, and higher pre-dialysis blood pressure levels.

Palavras Chave

Headache, hemodialysis, dialysis headache, blood pressure, anxiety, sleepiness