Prospective Study of Patient-Reported Outcomes After Endovascular Renal Ablation in Individuals with Chronic Kidney Pain and Opiate Use
Bibliographic record
Abstract
Background: Endovascular renal ablation (ERA) may be useful for palliating and in some instances relieving refractory kidney pain (RKP) but is not widely available. We report our experience of ERA in 20 patients with RKP. Methods: We conducted a prospective study of patient-reported outcomes pre and post ERA for RKP. Baseline & subsequent pain questionnaires (McGill Pain (MPQ), Brief Pain Inventory (BPI), Opioid oral morphine milligrams equivalent (MME)) & QOL (LASA-6, PHQ-9 & SF-8) were obtained. The Wilcoxon test was used. ERA using an open irrigated ablation catheter was performed in a spiral manner distal to proximal upto the renal artery ostium. Power was titrated between 5-30 watts guided by change in impedance. Results: We performed 24 ERA (3 bilateral, 21 unilateral; 4 redos) in 20 patients, female:male; 14:6; median age 40yr. 12 patients (60%) had Loin Pain Hematuria Syndrome(LPHS), 4 (20%) ADPKD, and others 4 (20%). 17 of 20 have completed the baseline questionnaires & 9 of 17 patients have 6mo data. All nine experienced variable or complete reductions in pain & QOL from baseline to 6mo (Table1). A median of 8mo pain relief was reported. After their first ERA, responders (pain relief >6mo) median 8.5mo (n=12/20;60%) while 4 (20%) reported pain relief <6mo (non-responders) median 2mo. 3 (15%) had no relief, and 1 was lost to FU. In the redo ERA, there was no relief in 2; in 1 pain relief lasted 4mo (non-responder), and in the other, relief was 8mo (responder). Following the first ERA, MME decreased by ≥30% in 6, increased in 7 (≥30% in 6;15% in 1), was unchanged in 3, and no data was available in 4. There were 3 access site hematomas, one acute renal artery dissection (procedure related) requiring stents & one renal artery stenosis (5mo later) treated by percutaneous transluminal angioplasty but subsequent reduced kidney function. Conclusions: Among patients with RKP undergoing ERA, half achieved objective improvement in pain & QOL at 6 mo. Prospective randomized studies with careful patient selection are required to assess the role of ERA for palliation of pain. Assessments of Pain & QOL
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".