Prevalence of low back pain in hemodialysis patients: A systematic review and meta-analysis with Grading of Recommendations Assessment, Development, and Evaluation evidence classification.

Background: Musculoskeletal pain complaints have a high epidemiological and clinical burden in hemodialysis patients. Previous original studies indicate that low back pain (LBP) may have an important contribution to these complaints. This systematic review aimed to estimate the global prevalence of LBP in chronic hemodialysis patients.

Methods: Systematic review and meta-analysis with Grading of Recommendations Assessment, Development, and Evaluation approach for quality of evidence. Searches were performed in CINAHL, Embase, LILACS, MEDLINE/PubMed, and Scientific Electronic Library Online databases until July 2023. The Inverse Variance Heterogeneity model was used to pool prevalence estimates.

Results: The review included 19 original articles that provided data from 2713 patients. The overall pooled prevalence of LBP was 30.2% (95% confidence interval [CI] =19.0%-42.0%; k = 19 articles). The sex-specific pooled prevalence of LBP was 29.6% (95% CI = 18.7%-41.2%; k = 6 articles) in females and 36.6% (95% CI = 26.0%-47.7%; k = 6 articles) in males. The duration-specific pooled prevalence of LBP was 13.2% (95% CI = 8.6%-18.4%; k = 2 articles) for acute and 30.7% (95% CI = 11.3%-52.2%; k = 7 articles) for chronic LBP. The frequency of LBP estimated over the total number of pain complaints was 39.6% (95% CI = 23.0%-56.8%; k = 10 articles).

Conclusion: The overall estimate shows that three out of 10 hemodialysis patients suffer from LBP. This condition is accountable for nearly 40% of pain complaints in such patients. The quality of evidence for the pooled estimates is low or very low, and future prevalence studies with adequate statistical power and definitions of LBP are needed to provide more accurate data.