NEUROPATHIC PAIN AND NEURO-IMMUNE DYSREGULATION IN CHRONIC KIDNEY DISEASE AFTER COVID-19

T. Razlog¹, E. Russu², C. Groza¹, L. Groppa³ | ¹Timofei Mosneaga Republican Clinical Hospital, Chisinau, Republic of Moldova; ²Nicolae Testemitanu State Medical and Pharmaceutical University; Timofei Mosneaga Republican Clinical Hospital, Chisinau, Republic of Moldova; ³Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova

Abstract

Background and Aims. Neuropathic pain is a frequent but under-recognized component of chronic kidney disease (CKD). Post-coronavirus disease 2019 (COVID-19), neuro-immune dysregulation may further amplify neuropathic mechanisms through persistent inflammation and altered nociceptive signaling. This study aimed to investigate neuropathic pain features and their association with inflammatory markers in CKD patients after COVID-19.
Methods. A cross-sectional study included 280 CKD patients (140 post-COVID, 140 non-COVID controls). Neuropathic pain was assessed using clinical descriptors (burning pain, paresthesia, and allodynia) and pain intensity (visual analog scale). Functional status was evaluated using the Short Form-36 Health Survey. Biological parameters included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin, and hemoglobin. Statistical analysis included correlation, subgroup analysis, and multivariate regression.
Results. Neuropathic pain features were more frequent in post-COVID patients (41% vs. 26%; p=0.01), particularly burning pain and paresthesia. Pain intensity was higher in patients with neuropathic characteristics (6.5±1.2 vs. 5.3±1.4; p=0.003). CRP levels were significantly elevated in patients with neuropathic pain (11.2±6.4 vs. 6.3±4.1 mg/L; p=0.001) and correlated with pain severity (r=0.29; p=0.002). ESR showed similar associations (r=0.26; p=0.004). Patients with both elevated CRP (>10 mg/L) and anemia had the highest pain burden (VAS 6.8 ± 1.0; p < 0.001). Multivariate analysis identified CRP (β=0.31; p=0.003) and hemoglobin (β=−0.27; p=0.006) as independent predictors of neuropathic pain (R²=0.37).
Conclusions. Neuropathic pain is more prevalent in CKD patients after COVID-19 and is strongly associated with persistent inflammation. Neuro-immune mechanisms may play a central role, suggesting that anti-inflammatory and neuro-modulatory strategies could improve pain outcomes in this population.