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Rickard M, Lorenzo AJ, Goraya N, Kim JJ, Khondker A, Yadav P, Richter J, Chua M, Santos JD. The impact of posterior urethral valves on pediatric quality of life and family function: Prospective analysis of serial patients managed in a dedicated multidisciplinary clinic. J Pediatr Urol 2024:S1477-5131(24)00266-3. [PMID: 38824105 DOI: 10.1016/j.jpurol.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/03/2024] [Accepted: 05/11/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Posterior urethral valves (PUV) is a chronic condition that can adversely impact child and family health related quality of life (HRQOL). Surprisingly, to date, the impact of this condition on the QOL of children with PUV has not been studied. Thus, our aim is to evaluate this important aspect of care using validated questionnaires in our institutional PUV clinic. METHODS From December 2022 to January 2024, the PedsQL Inventory and associated family impact module was distributed in our PUV clinic. Higher scores reflect better HRQoL and less impact on family. Children >8 years old completed the tool themselves, otherwise parents completed the tools on behalf of the child. We compared PUV scores against reported psychometric data from healthy children and other chronic illnesses. RESULTS A total of 112 families completed the questionnaires. The total HRQoL score was 80 ± 13. Overall, we noted that the domains reflecting psychosocial impact were significantly lower than those of physical well-being (76 ± 16 vs. 89 ± 15 for psychosocial and physical impact, respectively; p < 0.01). There was a significant difference in the psychosocial emotional impact for children managed with clean intermittent catheterization (CIC) compared to those who were not (69 ± 21 vs. 81 ± 16; p = 0.005) (Table 2). In addition, we noted that children with PUV scored similar to healthy controls, but higher than children with other chronic illnesses. With respect to the impact on family, overall, parent, and family impacts were 76 ± 19, 78 ± 21, and 81 ± 21, respectively. DISCUSSION Chronic illness has been associated with a negative impact on HRQoL in both adults and children. We noted similar findings the present study, particularly for young children and those who are maintained on CIC. To our knowledge, this is the first study to evaluate the impact of PUV on a child's HRQoL as well as the impact on the family, and to document a negative psychosocial impact of CIC in this population. However, there are some important limitations to be addressed including relying on families to complete questionnaires accurately during busy clinic visits and the lack of controls from the same environment. CONCLUSION When compared to healthy controls, PUV patients score similarly in HRQoL assessment. In addition, children <3years of age report a negative impact on physical well being, and CIC negatively impacts the emotional well-being. These data can be used to advocate for better mental health supports and social work for these children.
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Affiliation(s)
- Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Noreen Goraya
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jin Jyu Kim
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Renal Sciences, Lucknow, India
| | - Juliane Richter
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Shingde R, Guha C, van Zwieten A, Kim S, Walker A, Francis A, Didsbury M, Teixeira-Pinto A, Prestidge C, Lancsar E, Mackie F, Kwon J, Howard K, Howell M, Jaure A, Hayes A, Raghunandan R, Petrou S, Lah S, McTaggart S, Craig JC, Mallitt KA, Wong G. Longitudinal associations between socioeconomic position and overall health of children with chronic kidney disease and their carers. Pediatr Nephrol 2024; 39:1533-1542. [PMID: 38049703 DOI: 10.1007/s00467-023-06236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Disadvantaged socioeconomic position (SEP) is an important predictor of poor health in children with chronic kidney disease (CKD). The time course over which SEP influences the health of children with CKD and their carers is unknown. METHODS This prospective longitudinal study included 377 children, aged 6-18 years with CKD (stages I-V, dialysis, and transplant), and their primary carers. Mixed effects ordinal regression was performed to assess the association between SEP and carer-rated child health and carer self-rated health over a 4-year follow-up. RESULTS Adjusted for CKD stage, higher family household income (adjusted odds ratio (OR) (95% CI) 3.3, 1.8-6.0), employed status of primary carers (1.7, 0.9-3.0), higher carer-perceived financial status (2.6, 1.4-4.8), and carer home ownership (2.2, 1.2-4.0) were associated with better carer-rated child health. Household income also had a differential effect on the carer's self-rated health over time (p = 0.005). The predicted probabilities for carers' overall health being 'very good' among lower income groups at 0, 2, and 4 years were 0.43 (0.28-0.60), 0.34 (0.20-0.51), and 0.25 (0.12-0.44), respectively, and 0.81 (0.69-0.88), 0.84 (0.74-0.91), and 0.88 (0.76-0.94) for carers within the higher income group. CONCLUSIONS Carers and their children with CKD in higher SEP report better overall child and carer health compared with those in lower SEP. Carers of children with CKD in low-income households had poorer self-rated health compared with carers in higher-income households at baseline, and this worsened over time. These cumulative effects may contribute to health inequities between higher and lower SEP groups over time. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rashmi Shingde
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Siah Kim
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - Anna Francis
- School of Medicine, University of Queensland, Brisbane, Australia
- Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Madeleine Didsbury
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - Emily Lancsar
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Fiona Mackie
- Sydney Children's Hospital, Randwick, Australia
- School of Women's and Child Health, University of New South Wales, Kensington, Australia
| | - Joseph Kwon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy & Economics, School of Public Health, University of Sydney, Sydney, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy & Economics, School of Public Health, University of Sydney, Sydney, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Alison Hayes
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rakhee Raghunandan
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy & Economics, School of Public Health, University of Sydney, Sydney, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Steven McTaggart
- School of Medicine, University of Queensland, Brisbane, Australia
- Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
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van Zwieten A, Kim S, Dominello A, Guha C, Craig JC, Wong G. Socioeconomic Position and Health Among Children and Adolescents With CKD Across the Life-Course. Kidney Int Rep 2024; 9:1167-1182. [PMID: 38707834 PMCID: PMC11068961 DOI: 10.1016/j.ekir.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Children and adolescents in families of lower socioeconomic position (SEP) experience an inequitable burden of reduced access to healthcare and poorer health. For children living with chronic kidney disease (CKD), disadvantaged SEP may exacerbate their considerable disease burden. Across the life-course, CKD may also compromise the SEP of families and young people, leading to accumulating health and socioeconomic disadvantage. This narrative review summarizes the current evidence on relationships of SEP with kidney care and health among children and adolescents with CKD from a life-course approach, including impacts of family SEP on kidney care and health, and bidirectional impacts of CKD on SEP. It highlights relevant conceptual models from social epidemiology, current evidence, clinical and policy implications, and provides directions for future research. Reflecting the balance of available evidence, we focus primarily on high-income countries (HICs), with an overview of key issues in low- and middle-income countries (LMICs). Overall, a growing body of evidence indicates sobering socioeconomic inequities in health and kidney care among children and adolescents with CKD, and adverse socioeconomic impacts of CKD. Dedicated efforts to tackle inequities are critical to ensuring that all young people with CKD have the opportunity to live long and flourishing lives. To prevent accumulating disadvantage, the global nephrology community must advocate for local government action on upstream social determinants of health; and adopt a life-course approach to kidney care that proactively identifies and addresses unmet social needs, targets intervening factors between SEP and health, and minimizes adverse socioeconomic outcomes across financial, educational and vocational domains.
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Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Siah Kim
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Amanda Dominello
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Chandana Guha
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
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Newman H, Li Y, Huang YV, Elgarten CW, Myers RM, Ruiz J, Zheng DJ, Leahy AB, Aftandilian C, Arnold SD, Bona K, Gramatges MM, Heneghan MB, Maloney KW, Modi AJ, Mody RJ, Morgan E, Rubnitz J, Winick N, Wilkes JJ, Seif AE, Fisher BT, Aplenc R, Getz KD. Household income and health-related quality of life in children receiving treatment for acute myeloid leukemia: Potential impact of selection bias in health equity research. Cancer Med 2024; 13:e6966. [PMID: 38572962 PMCID: PMC10993703 DOI: 10.1002/cam4.6966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Examine the influence of household income on health-related quality of life (HRQOL) among children with newly diagnosed acute myeloid leukemia (AML). DESIGN Secondary analysis of data prospectively collected from pediatric patients receiving treatment for AML at 14 hospitals across the United States. EXPOSURE Household income was self-reported on a demographic survey. The examined mediators included the acuity of presentation and treatment toxicity. OUTCOME Caregiver proxy reported assessment of patient HRQOL from the Peds QL 4.0 survey. RESULT Children with AML (n = 131) and caregivers were prospectively enrolled to complete PedsQL assessments. HRQOL scores were better for patients in the lowest versus highest income category (mean ± SD: 76.0 ± 14 household income <$25,000 vs. 59.9 ± 17 income ≥$75,000; adjusted mean difference: 11.2, 95% CI: 2.2-20.2). Seven percent of enrolled patients presented with high acuity (ICU-level care in the first 72 h), and 16% had high toxicity (any ICU-level care); there were no identifiable differences by income, refuting mediating roles in the association between income and HRQOL. Enrolled patients were less likely to be Black/African American (9.9% vs. 22.2%), more likely to be privately insured (50.4% vs. 40.7%), and more likely to have been treated on a clinical trial (26.7% vs. 18.5%) compared to eligible unenrolled patients not enrolled. Evaluations of potential selection bias on the association between income and HRQOL suggested differences in HRQOL may be smaller than observed or even in the opposing direction. CONCLUSIONS While primary analyses suggested lower household income was associated with superior HRQOL, differential participation may have biased these results. Future studies should partner with patients/families to identify strategies for equitable participation in clinical research.
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Affiliation(s)
- Haley Newman
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yimei Li
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yuan‐Shung V. Huang
- Department of Biomedical and Health InformaticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Caitlin W. Elgarten
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Regina M. Myers
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jenny Ruiz
- Division of Hematology‐Oncology, Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Daniel J. Zheng
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Alison Barz Leahy
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Catherine Aftandilian
- Division of Pediatric Hematology‐Oncology, Stem Cell Transplant and Regenerative Medicine, Department of PediatricsStanford UniversityStanfordCaliforniaUSA
| | - Staci D. Arnold
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaEmory University School of MedicineAtlantaGeorgiaUSA
| | - Kira Bona
- Division of Population Sciences, Department of Pediatric OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - M. Monica Gramatges
- Division of Pediatric Hematology‐Oncology, Department of PediatricsTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Mallorie B. Heneghan
- Division of Pediatric Hematology‐Oncology, Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kelly W. Maloney
- Department of Pediatrics‐Hematology/Oncology and Bone Marrow Transplant, University of Colorado Cancer CenterChildren's Hospital ColoradoAuroraColoradoUSA
| | - Arunkumar J. Modi
- Division of Hematology Oncology, Department of PediatricsUniversity of Arkansas for Medical Sciences, Arkansas Children's HospitalLittle RockArkansasUSA
| | - Rajen J. Mody
- Department of PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Elaine Morgan
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jeffrey Rubnitz
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Naomi Winick
- Department of Pediatric Hematology OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jennifer J. Wilkes
- Division of Cancer and Blood Disorders, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Alix E. Seif
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Brian T. Fisher
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Division of Infectious Disease, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Richard Aplenc
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kelly D. Getz
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Mai K, Dawson AE, Gu L, LaMotte JE, Molitor S, Zimmerman CT. Common mental health conditions and considerations in pediatric chronic kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06314-8. [PMID: 38456918 DOI: 10.1007/s00467-024-06314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
The mental health of youth with chronic kidney disease (CKD) has been increasingly recognized as an area of clinical need. The development of mental health concerns is influenced by a range of physiological, psychological, and environmental factors. Some of these factors are common across child development, but some are more unique to youth with CKD. Mental health concerns are associated with increased risk for a range of poor medical outcomes (e.g., adherence, risk of transplant rejection) and quality of life concerns. In this educational review, we discuss the current evidence base regarding the development of mental health concerns in youth with CKD. The review covers multiple domains including mood and anxiety disorders, traumatic stress, and neurodevelopmental disorders. Estimated prevalence and hypothesized risk factors are outlined, and the potential impact of mental health on medical care and functional outcomes are reviewed. Finally, we introduce options for intervention to support positive mental health and offer recommendations for building access to mental health care and improving the mental health education/training of medical professionals.
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Affiliation(s)
- Katherine Mai
- Division of Pediatric Nephrology, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11364, USA.
| | - Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lidan Gu
- Division of Clinical Behavioral Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Julia E LaMotte
- Division of Child and Adolescent Psychiatry, Riley Children's Health, Indianapolis, IN, USA
| | - Stephen Molitor
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Cortney T Zimmerman
- Division of Psychology and Nephrology Service, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, 77030, USA
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Verhofste SL, Conrad AL, Johnson RJ, Steinbach EJ, Staber JM, Harshman LA. Self-concept and academic achievement in children with chronic kidney disease. Pediatr Nephrol 2024; 39:819-827. [PMID: 37594577 PMCID: PMC10999179 DOI: 10.1007/s00467-023-06106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Within the pediatric population, a positive self-concept is associated with better academic achievement. Children with chronic kidney disease (CKD) are at risk for lower quality of life and academic underachievement. Little is known about self-concept among children with CKD and how self-concept influences academic achievement. The objectives of the present study were to (1) describe patient-reported self-concept among children with CKD and (2) evaluate the relationship between self-concept and academic performance. METHODS This cross-sectional study included 23 children, aged 6-16 years, with mild to moderate CKD (cause of disease due to congenital anomalies of the kidney and urinary tract) and 26 age-matched comparators. Participants completed the Self-Description Questionnaire (SDQ) and the Wide Range Achievement Test (WRAT-4). Linear regression models were used to evaluate self-concept as a predictor of academic achievement in the CKD cohort. RESULTS Self-concept ratings were comparable between children with CKD and non-CKD comparators; however, academic achievement trended lower for the CKD patients on measures of arithmetic (estimate = - 0.278, 95% confidence interval (CI) [- 0.530: - 0.026], t(45) = - 1.99, p = 0.053). All of the SDQ domains predicted WRAT-4 arithmetic performance, such that higher scores on the SDQ were associated with higher scores in mathematics. Kidney function did not have an effect on the relationship between self-concept and academic achievement. CONCLUSIONS Despite the presence of a chronic disease, children with CKD endorse a positive self-concept. Positive self-concept may predict academic success in this population.
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Affiliation(s)
- Silvia L Verhofste
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Amy L Conrad
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Rebecca J Johnson
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, USA
| | - Emily J Steinbach
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Janice M Staber
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Lyndsay A Harshman
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA.
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Honda K, Akune Y, Goto R. Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan. JAMA Netw Open 2024; 7:e2356412. [PMID: 38363568 PMCID: PMC10873767 DOI: 10.1001/jamanetworkopen.2023.56412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024] Open
Abstract
Importance The evidence for and against screening for chronic kidney disease in youths who are asymptomatic is inconsistent worldwide. Japan has been conducting urinary screening in students for 50 years, allowing for a full economic evaluation that includes the clinical benefits of early detection and intervention for chronic kidney disease. Objectives To evaluate the clinical effectiveness and cost-effectiveness of school urinary screening in Japan, with a focus on the benefits of the early detection and intervention for IgA nephropathy, and to explore key points in the model that are associated with the cost-effectiveness of the school urinary screening program. Design, Setting, and Participants This economic evaluation with a cost-effectiveness analysis used a computer-simulated Markov model from the health care payer's perspective among a hypothetical cohort of 1 000 000 youths aged 6 years in first grade in Japanese elementary schools, followed up through junior and high school. The time horizon was lifetime. Costs and clinical outcomes were discounted at a rate of 2% per year. Costs were calculated in Japanese yen and 2020 US dollars (¥107 = US $1). Interventions School urinary screening for IgA nephropathy was compared with no screening. Main Outcomes and Measures Outcomes were costs and quality-adjusted life-years (QALYs). Cost-effectiveness was determined by evaluating whether the incremental cost-effectiveness ratio (ICER) per QALY gained remained less than ¥7 500 000 (US $70 093). Results In the base case analysis, the ICER was ¥4 186 642 (US $39 127)/QALY, which was less than the threshold. There were 60.3 patients/1 000 000 patients in the no-screening strategy and 31.7 patients/1 000 000 patients in the screening strategy with an end-stage kidney disease. Cost-effectiveness improved as the number of screenings decreased (screening frequency <3 times: incremental cost, -¥75 [US $0.7]; incremental QALY, 0.00025; ICER, dominant), but the number of patients with end-stage kidney disease due to IgA nephropathy increased (40.9 patients/1 000 000 patients). Assuming the disutility due to false positives had a significant impact on the analysis; assuming a disutility of 0.01 or more, the population with no IgA nephropathy had an ICER greater than the threshold (¥8 304 093 [US $77 608]/QALY). Conclusions and Relevance This study found that Japanese school urinary screening was cost-effective, suggesting that it may be worthy of resource allocation. Key factors associated with cost-effectiveness were screening cost, the probability of incident detection outside of screening, and IgA nephropathy incidence, which may provide clues to decision-makers in other countries when evaluating the program in their own context.
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Affiliation(s)
- Kimiko Honda
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
- Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Yoko Akune
- Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Rei Goto
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
- Graduate School of Health Management, Keio University, Tokyo, Japan
- Graduate School of Business Administration, Keio University, Tokyo, Japan
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Wijaya EA, Solek P, Rachmadi D, Rahayuningsih SE, Tarigan R, Hilmanto D. Effect of Executive Function on Health-Related Quality of Life in Children with Chronic Kidney Disease. Int J Nephrol Renovasc Dis 2024; 17:17-28. [PMID: 38223907 PMCID: PMC10785681 DOI: 10.2147/ijnrd.s428657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction As the highest function in the brain that regulates our daily activity, executive dysfunction might affect someone's health-related quality of life (HRQoL), especially in those with chronic diseases, including chronic kidney disease (CKD). Neurocognitive functions, including intelligence quotient (IQ) and executive function can be affected through various mechanisms in CKD. However, there was still no specific study regarding how IQ and executive function might affect HRQoL in children with CKD. Purpose To assess Executive Function's impact on HRQoL and to find association between treatment modalities and CKD stages with HRQoL in children with CKD. Methods A cross sectional study was conducted at Pediatric Nephrology Clinic at Hasan Sadikin General Hospital, Bandung, Indonesia from September 2022 to April 2023. We included 38 children whose age range were 6-16 years 11 months old with CKD stage III - V. Assessment tools used were: BRIEF questionnaire for executive function; WISC III tool for IQ; PedsQLTM questionnaire generic module for HRQoL. Data was analyzed using SPSS ver. 26.0. Results Total number of samples was 38. Complete examinations were done on 30 patients. Eight other patients did not undergo the IQ test. There was a negative correlation between executive function components scores (GEC, BRI, MI) with HRQoL scores on parents' proxy in all domains. We found no correlation between HRQoL and IQ scores, but we found a correlation between IQ and CKD stage. There was a significant difference in HRQoL from the children's perspective among the three modalities; children who underwent conservative treatment were having the best HRQoL scores. Conclusion Interventions to improve executive function of children with CKD should be done to improve their HRQoL in the future. Early diagnosis and treatment of CKD should be done at the earliest to improve neurocognitive function and HRQoL.
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Affiliation(s)
- Elrika Anastasia Wijaya
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Purboyo Solek
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dedi Rachmadi
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Sri Endah Rahayuningsih
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rodman Tarigan
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dany Hilmanto
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Brown DD, Roem J, Ng DK, Coghlan RF, Johnstone B, Horton W, Furth SL, Warady BA, Melamed ML, Dauber A. Associations between collagen X biomarker and linear growth velocity in a pediatric chronic kidney disease cohort. Pediatr Nephrol 2023; 38:4145-4156. [PMID: 37466864 PMCID: PMC10642619 DOI: 10.1007/s00467-023-06047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Collagen X biomarker (CXM) is a novel biomarker of linear growth velocity. We investigated whether CXM correlated with measured growth velocity in children with impaired kidney function. METHODS We used data from children aged 2 through 16 years old enrolled in the Chronic Kidney Disease in Children (CKiD) study. We assessed the association between CXM level and growth velocity based on height measurements obtained at study visits using linear regression models constructed separately by sex, with and without adjustment for CKD covariates. Linear mixed-effects models were used to capture the between-individual and within-individual CXM changes over time associated with concomitant changes in growth velocity from baseline through follow-up. RESULTS A total of 967 serum samples from 209 participants were assayed for CXM. CXM correlated more strongly in females compared to male participants. After adjustment for growth velocity and CKD covariates, only proteinuria in male participants affected CXM levels. Finally, we quantified the between- and within-participant associations between CXM level and growth velocity. A between-participant increase of 24% and 15% in CXM level in females and males, respectively, correlated with a 1 cm/year higher growth velocity. Within an individual participant, on average, 28% and 13% increases in CXM values in females and males, respectively, correlated with a 1 cm/year change in measured growth. CONCLUSIONS CXM measurement is potentially a valuable aid for monitoring growth in pediatric CKD. However, future research, including studies of CXM metabolism, is needed to clarify whether CXM can be a surrogate of growth in children with CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Denver D Brown
- Division of Nephrology, Children's National Hospital/Department of Pediatrics, George Washington School of Medicine, 111 Michigan Ave, Washington, NWDC, USA.
| | - Jennifer Roem
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Derek K Ng
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan F Coghlan
- Research Center, Shriners Hospital for Children, Portland, OR, USA
| | - Brian Johnstone
- Research Center, Shriners Hospital for Children, Portland, OR, USA
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR, USA
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - William Horton
- Research Center, Shriners Hospital for Children, Portland, OR, USA
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Susan L Furth
- Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michal L Melamed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew Dauber
- Division of Endocrinology, Children's National Hospital/Department of Pediatrics, George Washington School of Medicine, Washington, DC, USA
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Carlson J, Gerson AC, Matheson MB, Manne S, Lande M, Harshman L, Johnson RJ, Shinnar S, Kogon AJ, Warady B, Furth S, Hooper S. Longitudinal changes of health-related quality of life in childhood chronic kidney disease. Pediatr Nephrol 2023; 38:4127-4136. [PMID: 37428223 PMCID: PMC10591962 DOI: 10.1007/s00467-023-06069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Few longitudinal studies have evaluated the impact of chronic kidney disease (CKD) duration on health-related quality of life (HRQOL). The study's aim was to determine how HRQOL changes over time in childhood CKD. METHODS Study participants were children in the chronic kidney disease in children (CKiD) cohort who completed the pediatric quality of life inventory (PedsQL) on three or more occasions over the course of two or more years. Generalized gamma (GG) mixed-effects models were applied to assess the effect of CKD duration on HRQOL while controlling for selected covariates. RESULTS A total of 692 children (median age = 11.2) with a median of 8.3 years duration of CKD were evaluated. All subjects had a GFR greater than 15 ml/min/1.73 m2. GG models with child self-report PedsQL data indicated that longer CKD duration was associated with improved total HRQOL and the 4 domains of HRQOL. GG models with parent-proxy PedsQL data indicated that longer duration was associated with better emotional but worse school HRQOL. Increasing trajectories of child self-report HRQOL were observed in the majority of subjects, while parents less frequently reported increasing trajectories of HRQOL. There was no significant relationship between total HRQOL and time-varying GFR. CONCLUSIONS Longer duration of the disease is associated with improved HRQOL on child self-report scales; however, parent-proxy results were less likely to demonstrate any significant change over time. This divergence could be due to greater optimism and accommodation of CKD in children. Clinicians can use these data to better understand the needs of pediatric CKD patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Joann Carlson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Arlene C Gerson
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sharon Manne
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Marc Lande
- University of Rochester Medical Center, Rochester, NY, USA
| | - Lyndsay Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Rebecca J Johnson
- Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA
| | - Shlomo Shinnar
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amy J Kogon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Warady
- Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA
| | - Susan Furth
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Hooper
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Hsu CN, Tain YL, Lu PC, Lin HW. Comparisons of EQ-5D-Y and PedsQL in pediatric patients with mild-to-moderate chronic kidney disease in longitudinal analyses. Health Qual Life Outcomes 2023; 21:117. [PMID: 37891615 PMCID: PMC10605985 DOI: 10.1186/s12955-023-02197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To characterize longitudinal changes and correlations between the measures of EQ-5D-Y and generic PedsQL and their associations with clinical changes in children and adolescents with mild-to-moderate chronic kidney disease (CKD). METHODS Participants were recruited from January 2017 to September 2021 in a medical center in Taiwan. Both instruments were administered in their initial visits and every 6-month subsequent visits. Spearman's Rho (ρ) was used to assess correlations between the scores of EQ-5D-Y and PedsQL measures in longitudinal changes. Cohen's effect size (ES) was used to evaluate the changes of scores/subscales over time. In addition, factors associated with longitudinal changes in the score/subscales were explored. RESULTS A total of 121 participants were enrolled, and 83 with ≥ 3 HRQOL measures during the 3.5 years follow-up were assessed their changes of HRQOL measures. The correlations (ρ > 0.3) appeared between the changes in the visual analog scale (VAS) of EQ-5D-Y and emotional and social subscales of PedsQL. ES was small (< 0.5) in the VAS and level-sum-score (LSS) of EQ-5D-Y scores for the clinical changes in comorbidities, while some PedsQL subscales were medium to high (0.5-0.8 or > 0.8). Hypertension, mineral bone disorder/anemia, and hyperuricemia associated with the changes in both HRQOL scores were varied by their various domains. CONCLUSION Both EQ-5D-Y and PedsQL of HRQOL measures were responsive to worsened childhood CKD-related comorbidities during the follow-up; however, convergent validity between them was limited in some domains. The LSS of EQ-5D-Y showed greater changes than the VAS by comorbidity status; further comparison with utility weight is needed to determine the better performance of EQ-5D-Y.
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Affiliation(s)
- Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - You-Lin Tain
- Division of Pediatric Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Pei-Chen Lu
- Division of Pediatric Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Hsiang-Wen Lin
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, No. 100, Sec. 1, Jingmao Rd., Taichung City, 406040, Taiwan.
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan.
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
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Yurtdaş Depboylu G, Kaner G, Özdemir Şimşek Ö, Turan KN, Kasap Demir B. Dietary acid load in children with chronic kidney disease: its association with nutritional status and health-related quality of life. Pediatr Nephrol 2023; 38:3417-3426. [PMID: 37145186 DOI: 10.1007/s00467-023-05991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND This study aimed to determine the dietary acid load of children with chronic kidney disease (CKD) and to evaluate the relationship between dietary acid load, nutritional status, and health-related quality of life (HRQOL). METHOD A total of 67 children aged 3-18 years with a diagnosis of CKD stages II-V were included in the study. Anthropometric measurements (body weight, height, mid-upper arm circumference, waist, and neck circumference) and 3-day food consumption records were taken to evaluate the nutritional status. The net endogenous acid production (NEAP) score was calculated to determine the dietary acid load. "Pediatric Inventory of Quality of Life (PedsQL)" was used to assess the participants' HRQOL. RESULTS The mean NEAP was 59.2 ± 18.96 mEq/day. Stunted and malnourished children had significantly higher NEAP than those who were not (p < 0.05). There were no significant differences in terms of HRQOL scores according to NEAP groups. The multivariate logistic regression analysis showed that waist circumference (OR: 0.890, 95% CI: 0.794-0.997), serum albumin (OR: 0.252, 95% CI: 0.068-0.929), and glomerular filtration rate (GFR) (OR: 0.985, 95% CI: 0.970-1.000) were negatively associated with high NEAP. CONCLUSION This study shows that a diet shifted in an acidic direction in children with CKD and a higher dietary acid load are associated with lower serum albumin, GFR, and waist circumference, but not HRQOL. These results suggest that dietary acid load might affect nutritional status and CKD progression in children with CKD. Future studies with larger samples are needed to confirm these results and to understand underlying mechanisms. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Gamze Yurtdaş Depboylu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İzmir Katip Çelebi University, Çiğli Ana Yerleşkesi, Merkezi Ofisler 35620 Çiğli, İzmir, Turkey.
| | - Gülşah Kaner
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İzmir Katip Çelebi University, Çiğli Ana Yerleşkesi, Merkezi Ofisler 35620 Çiğli, İzmir, Turkey
| | - Özgür Özdemir Şimşek
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Kübra Nur Turan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İzmir Katip Çelebi University, Çiğli Ana Yerleşkesi, Merkezi Ofisler 35620 Çiğli, İzmir, Turkey
| | - Belde Kasap Demir
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Pediatrics, Division of Nephrology and Rheumatology, İzmir Katip Çelebi University, İzmir, Turkey
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13
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Dandamudi R, Twombley K, Flynn JT, Kakajiwala A, Chand DH. Physician knowledge, attitudes, and practices regarding physical activity restrictions in pediatric hemodialysis patients. Hemodial Int 2023; 27:345-351. [PMID: 37211958 DOI: 10.1111/hdi.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Epidemiologic studies of physical activity among pediatric hemodialysis (HD) patients are lacking. A sedentary lifestyle in End-Stage Kidney Disease is associated with a higher cardiovascular mortality risk. In those patients receiving HD, time spent on dialysis and restrictions on physical activity due to access also contribute. No consensus exists regarding physical activity restrictions based on vascular access type. The aim of this study was to describe the patterns of physical activity restrictions imposed by pediatric nephrologists on pediatric HD patients and to understand the basis for these restrictions. METHODS We conducted a cross-sectional study involving US pediatric nephrologists using an anonymized survey through Pediatric Nephrology Research Consortium. The survey consisted of 19 items, 6 questions detailed physician characteristics with the subsequent 13 addressing physical activity restrictions. FINDINGS A total of 35 responses (35% response rate) were received. The average years in practice after fellowship was 11.5 years. Significant restrictions were placed on physical activity and water exposure. None of the participants reported accesses damage or loss that was attributed to physical activity and sport participation. Physicians practice is based on their personal experience, standard practice at their HD center, and clinical practices they were taught. DISCUSSION There is no consensus among pediatric nephrologists about allowable physical activity in children receiving HD. Due to the lack of objective data, individual physician beliefs have been utilized to restrict activities in the absence of any deleterious effects to accesses. This survey clearly demonstrates the need for more prospective and detailed studies to develop guidelines regarding physical activity and dialysis access in order to optimize quality of care in these children.
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Affiliation(s)
- Raja Dandamudi
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine Twombley
- Department of Pediatrics, Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Aadil Kakajiwala
- Division of Nephrology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Deepa H Chand
- Novartis Pharmaceuticals, Bannockburn, Illinois, USA
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Illinois, University of Illinois College of Medicine-Peoria, Peoria, Illinois, USA
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14
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Girimaji N, Pais P, Iyengar A. Transition of Kidney Care at 18: Challenges and Practical Solutions for India. Indian J Nephrol 2023; 33:325-332. [PMID: 37881731 PMCID: PMC10593299 DOI: 10.4103/ijn.ijn_253_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 10/27/2023] Open
Abstract
Health-care transition (HCT) from pediatric-centered to adult-oriented health-care setting is more than a simple transfer of care. It is a carefully planned movement specially tailored for the needs of adolescents and young adults (AYAs). Similar to other chronic diseases, the need for HCT for AYAs with kidney disease has been well established by the International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA) consensus statements since 2011. However, successful HCT in India and other low- and middle-income countries (LMICs) has been limited. Undertaking the HCT program in India requires involvement of many stakeholders, that is, AYAs, parents/caregivers, health-care providers, and the health-care system. In this article, we discuss the need for HCT, the challenges faced during the transition, and the recommended models for HCT in kidney care. We focus on the unique challenges faced in India and conclude with practical suggestions to implement HCT in our setting.
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Affiliation(s)
- Niveditha Girimaji
- Department of Pediatric Nephrology, St. John’s Medical College, Bengaluru, Karnataka, India
| | - Priya Pais
- Department of Pediatric Nephrology, St. John’s Medical College, Bengaluru, Karnataka, India
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St. John’s Medical College, Bengaluru, Karnataka, India
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Patel R, Wong C. Illness-related parental stress and quality of life in children with kidney diseases. Pediatr Nephrol 2023; 38:2911-2913. [PMID: 37330454 DOI: 10.1007/s00467-023-06041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/19/2023]
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Elorza CLC, dos Santos A, Celeri EHRV. Quality of life, depression and anxiety in children and adolescents with CKD and their primary caregivers. J Bras Nefrol 2023; 45:335-343. [PMID: 36745054 PMCID: PMC10697160 DOI: 10.1590/2175-8239-jbn-2022-0036en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires long-lasting treatments and severe changes in the routine of children, which may favor a low quality of life (QoL) and damage to their mental health and that of their primary caregivers (PC). The present study aimed to investigate the presence of anxiety and depression and to analyze the QoL of children and adolescents diagnosed with CKD at stages 3, 4, and 5, and their PC. METHODS We carried out an observational case-control study with 29 children and adolescents and their PC as the case group and 53 as the control group. International instruments, validated for the Brazilian population, were used: Child Anxiety Inventory (STAI-C), Pediatric Quality of Life Inventory (PEDSQL), Child Depression Inventory (CDI), Beck Anxiety and Depression Inventory (BAI; BDI), and the WHOQOL-bref. RESULTS The study identified statistically significant differences in the PEDSQL total score (control group, 72.7 ± 19.5; case group, 63.3 ± 20.6; p = 0.0305) and in the psychosocial (control group, 70.5 ± 20.5 and case group, 61.4 ± 19.7; p = 0.0420) and school health dimensions (control group, 72.9 ± 21.0 and case group, 55.2 ± 19.8; p = 0.0003) and the presence of psychiatric comorbidity (depression and anxiety symptoms) in the case group (p = 0.02). As for PC, the study showed statistical significance for the prevalence of depression (p = 0.01) and anxiety (p = 0.02) symptoms. CONCLUSION Patients with CKD have lower QoL indices and more psychiatric comorbidities, and their PC are affected by the disease, with higher indices of depression and anxiety.
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Affiliation(s)
- Cibele Longobardi Cutinhola Elorza
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP,
Brazil
| | - Amilton dos Santos
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Psicologia Médica e Psiquiatria, Campinas, SP, Brazil
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Bakar KA, Muhamad NA, Sarpin MA, Shaharudin S, Sidhu S, Yap SL, Hussain THT, Tan HL, Ong FN, Gan WC, Ilias MI, Othman J, Eng CSY. Health-related quality of life amongst children with chronic kidney disease in Malaysia: performance of the Bahasa Melayu version of the PedsQL 3.0 ESRD Module : (PedsQL 3.0 VerBATIM: version in Bahasa Melayu. Translated for use in Malaysia). Pediatr Nephrol 2023; 38:1897-1905. [PMID: 36272027 DOI: 10.1007/s00467-022-05774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/31/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The PedsQL 3.0 End Stage Renal Disease (ESRD) Module is a well-accepted instrument internationally but it is not available in the local language. We aimed to validate the Bahasa Melayu (Malay language) version and determine the health-related quality of life (HRQoL) scores amongst children with CKD in Malaysia. METHODS The source questionnaire in English was translated into Bahasa Melayu. Linguistic validation guidelines by the MAPI Research Institute were followed. The already validated Bahasa Melayu PedsQL 4.0 Generic Core Scales was used for comparison. Sociodemographic data were collected during the interview. Statistical analyses were performed using SPSS version 25.0. RESULTS Sixty-nine children aged 8 to 18 with CKD stages 4 and 5, with or without dialysis, and their caregivers were recruited. Mean age was 12.62 ± 2.77 (SD). Evaluation of the PedsQL 3.0 ESRD Module Bahasa Melayu version demonstrated good internal consistency (Cronbach alpha 0.82). There was good agreement between child self-report and parent proxy report in all domains; average intraclass correlation coefficients (ICC) were 0.78, 95% CI (0.71, 0.84). Scores obtained from Generic 4.0 scales correlated with the disease-specific ESRD 3.0 scale, Spearman's rho = 0.32, p = 0.007. The Kruskal-Wallis H test indicated that there were no significant differences between stages of CKD and their respective mean HRQoL score, χ2(2) = 2.88, p = 0.236. CONCLUSIONS The PedsQL 3.0 ESRD Module Bahasa Melayu version is a reliable and feasible tool for cross-cultural adaptation. A longer prospective study may help better illustrate the quality of life in this group of children.
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Affiliation(s)
- Kamila Abu Bakar
- Paediatric Department, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor Asiah Muhamad
- Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Mohamad Alwi Sarpin
- Paediatric Department, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Sangeet Sidhu
- Paediatric Department, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | - Suet Li Yap
- Paediatric Department, Hospital Umum Sarawak, Kuching, Malaysia
| | | | - Hai Liang Tan
- Paediatric Nephrology Unit, Paediatric Department, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Fen Ni Ong
- Paediatric Department, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - Wen Chian Gan
- Paediatric Department, Hospital Selayang, Selangor, Malaysia
| | - Mohammad Ikram Ilias
- Department of Paediatric, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Juliana Othman
- Department of Language and Literacy Education, Universiti Malaya, Kuala Lumpur, Malaysia
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Dryjańska N, Kiliś-Pstrusińska K. Depression in Children and Adolescents with Chronic Kidney Disease-Review of Available Literature. J Clin Med 2023; 12:jcm12103554. [PMID: 37240660 DOI: 10.3390/jcm12103554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Depression is a significant health problem gaining increasing relevance, especially among children and adolescents. It is known that the incidence of depression is higher in patients suffering from chronic diseases, such as chronic kidney disease (CKD). This review aims to discuss the prevalence of depression in children and adolescents with CKD and its impact on the quality of life of these patients (HRQoL). The research was conducted using online databases with keywords: depression in children and adolescents, depression and chronic diseases, chronic kidney disease, and health-related quality of life. It was found that the risk for developing depression is higher for adolescents and females, and with the use of negative coping strategies, lack of caregiver nurturance, and poor socioeconomic status. In patients with pediatric CKD, the stage of the disease, age of CKD diagnosis, and type of treatment were found to significantly impact HRQoL and contribute to caregiver burden. Depression was more commonly found in children suffering from CKD. It causes significant mental distress to the child and contributes to the caregiver's burden. Screening for depression among CKD patients is advised. In depressed patients, transdiagnostic tools should be used to alleviate some of the symptoms. In children at risk of developing depression, preventative strategies should be considered.
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Affiliation(s)
- Natalia Dryjańska
- Clinical Department of Paediatric Nephrology, University Hospital in Wroclaw, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Katarzyna Kiliś-Pstrusińska
- Clinical Department of Paediatric Nephrology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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19
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Comparison of effectiveness of Nintendo Wii-based exergaming and home-based fun video exercises in pediatric patients with chronic kidney disease. Int J Rehabil Res 2023; 46:26-34. [PMID: 36416089 DOI: 10.1097/mrr.0000000000000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Functional capacity and quality of life (QoL) are reduced in children and adults with chronic kidney disease (CKD). Aerobic, strengthening exercises, and exergames are reported as effective in the treatment of symptoms associated with CKD. Unlike adult patients, there are insufficient studies investigating the effects of exercise on disease-related symptoms in pediatric CKD. This study aimed to compare the effects of Nintendo Wii-based exergaming and home-based fun video exercises on functional capacity, muscle strength, physical activity (PA), depression, fatigue, and QoL in pediatric patients with CKD. Twenty-three pediatric patients with CKD were included in the study and randomized to group I (Nintendo Wii Fit) and group II (home-based fun video exercises). Patients in both groups underwent exercise programs twice per week for 6 weeks. Functional capacity, muscle strength, PA, QoL, fatigue, and depression of the patients were evaluated before and after the treatments. Sixteen patients completed the study. After treatment, significant differences were observed in both groups on 6MWT, muscle strength, average daily steps, PedsQoL Child Self-Report PHSS, and the Visual Fatigue Scale. Left knee flexor muscle strength and average step counts were found to be superior in group I. Both exergaming and home-based fun video exercises provide positive effects on functional capacity, muscle strength, fatigue, PA, depression, and QoL in pediatric patients with CKD. We think that these exercise methods can help to protect physical and mental health of patients and should be included in treatment from the early stages of the disease.
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20
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Elorza CLC, Santos Junior AD, Celeri EHRV. Qualidade de vida, depressão e ansiedade em crianças e adolescentes com DRC e seus cuidadores primários. J Bras Nefrol 2023. [DOI: 10.1590/2175-8239-jbn-2022-0036pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
RESUMO Introdução: A doença renal crônica (DRC) requer tratamentos duradouros e alterações severas na rotina de crianças, o que pode favorecer baixa qualidade de vida (QV) e danos à sua saúde mental e à de seus cuidadores primários (CP). O presente estudo teve como objetivo investigar a presença de ansiedade e depressão e analisar a QV de crianças e adolescentes diagnosticados com DRC nos estágios 3, 4, 5, e seus CP. Métodos: Realizamos estudo observacional de caso-controle com 29 crianças e adolescentes e seus CP como grupo de casos e 53 como grupo controle. Utilizamos instrumentos internacionais, validados para a população brasileira: Inventário de Ansiedade Traço-Estado Infantil (IDATE-C), Questionário Pediatric Quality of Life (PEDSQL), Inventário de Depressão Infantil (CDI), Inventário de Ansiedade e Depressão de Beck (BAI; BDI), e o WHOQOL-bref. Resultados: O estudo identificou diferenças estatisticamente significativas no escore total do PEDSQL (grupo controle, 72,7 ± 19,5; grupo de casos, 63,3 ± 20,6; p = 0,0305), no psicossocial (grupo controle, 70,5 ± 20,5; grupo de casos, 61,4 ± 19,7; p = 0,0420), nas dimensões de saúde escolar (grupo controle, 72,9 ± 21,0; grupo de casos, 55,2 ± 19,8; p = 0,0003) e na presença de comorbidade psiquiátrica (sintomas de depressão e ansiedade) no grupo de casos (p = 0,02). Quanto aos CP, o estudo demonstrou significância estatística para a prevalência de sintomas de depressão (p = 0,01) e ansiedade (p = 0,02). Conclusão: Pacientes com DRC apresentam índices mais baixos de QV e mais comorbidades psiquiátricas, e seus CP são afetados pela doença, com índices maiores de depressão e ansiedade.
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21
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Guha C, van Zwieten A, Khalid R, Kim S, Walker A, Francis A, Didsbury M, Teixeira-Pinto A, Barton B, Prestidge C, Lancsar E, Mackie F, Kwon J, Howard K, Mallitt KA, Howell M, Jaure A, Hayes A, Raghunandan R, Petrou S, Lah S, McTaggart S, Craig JC, Wong G. Longitudinal assessment of the health-related quality of life of children and adolescents with chronic kidney disease. Kidney Int 2023; 103:357-364. [PMID: 36374824 DOI: 10.1016/j.kint.2022.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/27/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
In this multi-center longitudinal cohort study conducted in Australia and New Zealand, we assessed the trajectories of health-related quality of life (HRQoL) in children with chronic kidney disease (CKD) over time. A total of 377 children (aged 6-18 years) with CKD stages 1-5 (pre-dialysis), dialysis, or transplant, were followed biennially for four years. Multi Attribute Utility (MAU) scores of HRQoL were measured at baseline and at two and four years using the McMaster Health Utilities Index Mark 3 tool, a generic multi-attribute, preference-based system. A multivariable linear mixed model was used to assess the trajectories of HRQoL over time in 199 children with CKD stage 1-5, 43 children receiving dialysis and 135 kidney transplant recipients. An interaction between CKD stage at baseline and follow-up time indicated that the slopes of the HRQoL scores differed between children by CKD stage at inception. Over half of the cohort on dialysis at baseline had received a kidney transplant by the end of year four and the MAU scores of these children increased by a meaningful amount averaging 0.05 (95% confidence interval 0.01 to 0.09) per year in comparison to those who were transplant recipients at baseline. The mean difference between baseline and year two MAU scores was 0.09 (95% confidence interval -0.05, 0.23), (Cohen's d effect size 0.31). Thus, improvement in HRQoL over time of children on dialysis at baseline was likely to have been driven by their transition from dialysis to transplantation. Additionally, children with CKD stage 1-5 and transplant recipients at baseline had no changes in their disease stage or treatment modality and experienced stable HRQoL over time.
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Affiliation(s)
- Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| | - Anita van Zwieten
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Rabia Khalid
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Siah Kim
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Amanda Walker
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anna Francis
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia; Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Madeleine Didsbury
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Belinda Barton
- The Children's Hospital at Westmead and Paediatrics and Child Health (CHERI), University of Sydney, Sydney, New South Wales, Australia
| | | | - Emily Lancsar
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona Mackie
- Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Child Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Kwon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Menzies Centre for Health Policy & Economics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Alison Hayes
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rakhee Raghunandan
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Steven McTaggart
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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22
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Differences in health-related quality of life in children with chronic kidney disease as reported by children and parent proxies. Pediatr Nephrol 2023; 38:519-528. [PMID: 35678879 DOI: 10.1007/s00467-022-05621-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Correlation between reports of children and parent for health-related quality of life (HRQOL) is not well studied. This study aims to assess the degree of agreement between child self- and parent proxy-rated HRQOL and to identify factors associated with discordance at baseline and during follow-up in Taiwanese children with chronic kidney disease (CKD). METHODS This study includes pediatric patients aged 5-18 years with confirmed CKD. Participants completed the generic version of the Pediatric Quality of Life Inventory (PedsQL) at baseline and every 6 months during follow-up. Child-parent agreement on HRQOL reports was assessed using intraclass correlation coefficient (ICC). Multivariate regression models were used to determine factors associated with child-parent discordance. RESULTS Of the 112 child-parent dyads included in the analysis, 97 dyads with 640 patient visits were assessed in 4.5 years. Children reported higher total scores on the physical and psychosocial domains as compared to their parent proxies. ICC was low (< 0.5) for the psychosocial domain and moderate for the physical health domain at initial assessment and slightly increased for the physical health (0.62) and for school functioning (0.51) during follow-up. Development of mineral bone disorder/anemia (β, 11.75 [3.77-19.72]) and proteinuria (β, 8.48 [1.15-15.81]) in the follow-up were associated with increased discordance in school functioning, and fathers with chronic disease were associated with increased discordance in social functioning (β, 4.21 [0.68-7.74]). CONCLUSIONS Parent proxy consistently estimated lower PedsQL score compared to self-reports of children. Child self-rated psychosocial health domains should be evaluated whenever possible to better elucidate treatment outcome over time. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Heinzelmann MA, Kuehni CE, Roser K, Mader L, Laube GF. Health-related quality of life in adults after pediatric kidney failure in Switzerland. Pediatr Nephrol 2022; 38:1559-1568. [PMID: 36227439 PMCID: PMC10060264 DOI: 10.1007/s00467-022-05760-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about health-related quality of life (HRQoL) in adults after kidney failure during childhood. In this study, we analyzed HRQoL of adults after pediatric kidney failure in Switzerland and investigated socio-demographic and clinical factors associated with HRQoL. METHODS In this cohort study, we sent questionnaires to 143 eligible patients registered in the Swiss Pediatric Renal Registry with continuous kidney replacement therapy starting before the age of 18 years. We assessed HRQoL using the Short-Form 36 version 1, compared HRQoL scores between our sample and the Swiss general population, and used linear regression models to examine socio-demographic and clinical factors associated with HRQoL. RESULTS We included 79 patients (response rate 55%) with a mean age of 38.6 years (range 19.4-63.1). Compared to the general population, HRQoL scores were lower for physical functioning (- 12.43, p < 0.001), role physical (- 13.85, p = 0.001), general health (- 14.42, p < 0.001), vitality (- 4.98, p = 0.035), and physical HRQoL (- 6.11, p < 0.001), but we found no difference in mental HRQoL (- 0.13, p = 0.932). The socio-demographic factors-lower education, unemployment, and not being in a relationship-were associated with lower HRQoL. The only clinical factor associated with HRQoL was the type of kidney disease. Patients with acquired kidney diseases had lower mental HRQoL than patients with congenital anomalies of the kidney and urinary tract (- 11.4, p = 0.007) or monogenetic hereditary diseases (- 9.5, p = 0.018). CONCLUSIONS Adults after pediatric kidney failure in Switzerland have lower physical, but similar mental HRQoL compared to the general population. Subgroups may require special attention with regard to their HRQoL. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Marc-Andrea Heinzelmann
- Swiss Pediatric Renal Registry, Child and Adolescent Health Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | - Claudia E Kuehni
- Swiss Pediatric Renal Registry, Child and Adolescent Health Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Pediatrics, University Children's Hospital Bern, Bern, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Luzius Mader
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Guido F Laube
- Department of Pediatrics, Hospital Baden, Baden, Switzerland
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24
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Fatigue and Quality of Life in Children with Chronic Kidney Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091414. [PMID: 36138723 PMCID: PMC9497575 DOI: 10.3390/children9091414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022]
Abstract
Background: This study investigates the effect of chronic kidney disease (CKD) stage on fatigue and health-related quality of life (HRQoL) in the pediatric population. Material and Methods: The PedsQL (Pediatric Quality of Life Inventory) Multidimensional Fatigue Scale (subcategories: general, sleep/rest, and cognitive fatigue) and HRQoL Generic Core Scales (subcategories: physical, emotional, social, and school functioning) questionnaires were completed by 30 patients aged from 7 to 18 years old with CKD stage 2−4, CKD stage 5 on dialysis (CKD 5D), and kidney transplantation (KTx), as well as their parents. Results: Both low “Total Fatigue” and “Total HRQoL” scores were reported in 16.7% of patients. “Sleep/Rest Fatigue”, “Emotional Functioning”, and “School functioning” were the lowest scored subcategories. CKD 5D/KTx patients presented lower “Sleep/Rest Fatigue” (p = 0.022) and, more frequently, low “School Functioning” scores (p = 0.029). The “Total HRQoL” score was correlated to the “Total Fatigue” score (rs = 0.625, p < 0.001). A low “Sleep/Rest Fatigue” score was associated with low “Physical Functioning”, “School Functioning”, and “Total HRQoL” scores (p = 0.016, p = 0.001, and p = 0.047 respectively). Parents’ HRQoL score was lower than patients’ score on “Physical Functioning” (p = 0.040) and “School Functioning” subcategories (p = 0.045). Conclusions: Fatigue and disturbed HRQoL are mostly observed in CKD 5D and KTx pediatric patients, and are associated with sleep disorders and school dysfunction. Fatigue affects HRQoL, which is perceived as more deteriorated by the patients’ parents.
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25
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Panzarino V, Lesser J, Cassani FA. Pediatric Chronic Kidney Disease. Adv Pediatr 2022; 69:123-132. [PMID: 35985704 DOI: 10.1016/j.yapd.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) in children has a significant impact on morbidity, mortality, and quality of life. The degree of renal dysfunction should be calculated using pediatric-specific formulas and the degree of CKD staged; this allows for appropriate dosing of medications based on renal function and monitoring for progression and comorbid conditions including metabolic acidosis, bone disease, anemia, cardiovascular complications, malnutrition and electrolyte abnormalities, growth failure, and psychosocial issues. Treatment strategies include treating the underlying disease and using general renal protective measures. Effective management of these complex issues requires a specialized multidisciplinary team approach.
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Affiliation(s)
- Valerie Panzarino
- Department of Pediatrics, Division of Pediatric Nephrology, University of South Florida Health, 2 Tampa General Circle, Fifth Floor, Tampa, FL 33606, USA.
| | - Jake Lesser
- University of South Florida Health, 2 Tampa General Circle, Fifth Floor, Tampa, FL 33606, USA
| | - Frank Ayestaran Cassani
- Department of Pediatrics, Division of Pediatric Nephrology, University of South Florida Health, 2 Tampa General Circle, Fifth Floor, Tampa, FL 33606, USA
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26
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Kerklaan J, Hanson CS, Carter S, Tong A, Sinha A, Dart A, Eddy AA, Guha C, Gipson DS, Bockenhauer D, Hannan E, Yap HK, Groothoff J, Zappitelli M, Amir N, Alexander SI, Furth SL, Samuel S, Gutman T, Craig JC. Perspectives of Clinicians on Shared Decision Making in Pediatric CKD: A Qualitative Study. Am J Kidney Dis 2022; 80:241-250. [PMID: 35085686 DOI: 10.1053/j.ajkd.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Clinical decision-making priorities may differ among children, their parents, and their clinicians. This study describes clinicians' perspectives on shared decision making in pediatric chronic kidney disease (CKD) and identifies opportunities to improve shared decision making and care for children with CKD and their families. STUDY DESIGN Semistructured interviews. SETTING & PARTICIPANTS Fifty clinicians participated, including pediatric nephrologists, nurses, social workers, surgeons, dietitians, and psychologists involved in providing care to children with CKD. They worked at 18 hospitals and 4 university research departments across 11 countries (United States of America, Canada, Australia, People's Republic of China, United Kingdom, Germany, France, Italy, Lithuania, New Zealand, and Singapore). ANALYTICAL APPROACH Interview transcripts were analyzed thematically. RESULTS We identified 4 themes: (1) striving to blend priorities (minimizing treatment burden, emphasizing clinical long-term risks, achieving common goals), (2) focusing on medical responsibilities (carrying decisional burden and pressure of expectations, working within system constraints, ensuring safety is foremost concern), (3) collaborating to achieve better long-term outcomes (individualizing care, creating partnerships, encouraging ownership and participation in shared decision making, sensitive to parental distress), and (4) forming cumulative knowledge (balancing reassurance and realistic expectations, building understanding around treatment, harnessing motivation for long-term goals). LIMITATIONS Most clinicians were from high-income countries, so the transferability of the findings to other settings is uncertain. CONCLUSIONS Clinicians reported striving to minimize treatment burden and working with children and their families to manage their expectations and support their decision making. However, they are challenged with system constraints and sometimes felt the pressure of being responsible for the child's long-term outcomes. Further studies are needed to test whether support for shared decision making would promote strategies to establish and improve the quality of care for children with CKD.
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Affiliation(s)
- Jasmijn Kerklaan
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
| | - Camilla S Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Simon Carter
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Nagpur, India
| | - Allison Dart
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chandana Guha
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Detlef Bockenhauer
- Department of Renal Medicine University College London, and Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
| | - Elyssa Hannan
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Noa Amir
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Talia Gutman
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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27
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Kusumi K, Kremsdorf R, Kakajiwala A, Mahan JD. Pediatric Mineral and Bone Disorder of Chronic Kidney Disease and Cardiovascular Disease. Adv Chronic Kidney Dis 2022; 29:275-282. [PMID: 36084974 DOI: 10.1053/j.ackd.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022]
Abstract
Chronic kidney disease is common and causes significant morbidity including shortened lifespans and decrease in quality of life for patients. The major cause of mortality in chronic kidney disease is cardiovascular disease. Cardiovascular disease within the chronic kidney disease population is closely tied with disordered calcium and phosphorus metabolism and driven in part by renal bone disease. The complex nature of renal, bone, and cardiovascular diseases was renamed as mineral and bone disorder of chronic kidney disease to encompass how bone disease drives vascular calcification and contributes to the development of long-term cardiovascular disease, and recent data suggest that managing bone disease well can augment and improve cardiovascular disease status. Pediatric nephrologists have additional obstacles in optimal mineral and bone disorder of chronic kidney disease management such as linear growth and skeletal maturation. In this article, we will discuss cardiovascular and bone diseases in chronic kidney disease and end-stage kidney disease patients with a focus on pediatric issues and concerns.
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Affiliation(s)
- Kirsten Kusumi
- Department of Pediatric Nephrology, Akron Children's Hospital, Akron, OH.
| | - Robin Kremsdorf
- Pediatric Nephrology and Hypertension, Hasbro Children's Hospital, Providence, RI
| | - Aadil Kakajiwala
- Departments of Pediatric Critical Care Medicine and Nephrology, Children's National Hospital, Washington, DC
| | - John D Mahan
- Division of Nephrology and Hypertension at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
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28
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Aier A, Pais P, Raman V. Psychological aspects in children and parents of children with chronic kidney disease and their families. Clin Exp Pediatr 2022; 65:222-229. [PMID: 34773940 PMCID: PMC9082246 DOI: 10.3345/cep.2021.01004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric chronic kidney disease (CKD) is a chronic illness that affects the overall quality of life of patients during childhood. This article highlights the psychological and social burden of CKD in patients and their families. Patients with CKD and their families require comprehensive treatment for psychosocial problems. Therefore, it is crucial for pediatricians to screen for these issues and refer patients and their families for therapy. Tools that are short, easy to administer, and easy to score, such as the Pediatric Quality of Life Inventory or the Childhood Depression Inventory, can be utilized during routine clinical appointments. Reducing the negative impact of CKD on the family will improve the well-being and coping skills of patients and their families.
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Affiliation(s)
- Alemsungla Aier
- Department of Psychiatry, St. John's Medical College, Bangalore, India
| | - Priya Pais
- Department of Paediatric Nephrology, St. John's Medical College, Bangalore, India
| | - Vijaya Raman
- Department of Psychiatry, St. John's Medical College, Bangalore, India
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Alhamed AA, Toly VB, Hooper SR, Dell KM. The link between executive function, socio-emotional functioning and health-related quality of life in children and adolescents with mild to moderate chronic kidney disease. Child Care Health Dev 2022; 48:455-464. [PMID: 34893999 DOI: 10.1111/cch.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and adolescents with mild to moderate chronic kidney disease (CKD) are at high risk for mild but persistent impairment in executive functions, which have been associated with low health-related quality of life (HRQOL) among children and adolescents with chronic health conditions. However, no similar link has been established among children and adolescents with mild to moderate CKD. Given the essential role executive functions play in the development of adequate cognitive, emotional and social skills, it is essential to gain a clearer understating of the magnitude and attributes of executive functions and its link to HRQOL in order to inform appropriate medical and educational interventions for this patient population. OBJECTIVE The aim of this study is to examine the relationship between executive functions, socio-emotional functioning and HRQOL in children and adolescents with mild to moderate CKD. METHODS A cross-sectional design was used for this secondary data analysis of 199 children and adolescents (ages 6-17) with mild to moderate CKD from the United States and Canada who receive care at hospitals associated with the Chronic Kidney Disease in Children Study (CKiD). RESULTS The presence of impairment in executive functions and socio-emotional functioning (internalizing problems) significantly predicted lower HRQOL after controlling for key covariates (i.e., maternal education, anaemia and hypertension). Further, internalizing problems partially mediated the relationship between executive functions and HRQOL such that impairment in executive functions predicted lower HRQOL directly and indirectly by contributing to higher internalizing problems, which further contributed to low HRQOL. CONCLUSION This study underscores the importance of executive functions and socio-emotional functioning in the manifestation of HRQOL. Given that HRQOL is potentially compromised for many children and adolescents with mild to moderate CKD, it will be important for both clinicians and researchers to examine a range of factors, including executive functions and socio-emotional functioning, in order to optimize HRQOL.
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Affiliation(s)
- Arwa A Alhamed
- Nursing Department, College of Nursing, King Saud bin Abdulaizz University for Health Sciences, Riyadh, Saudi Arabia
| | - Valerie B Toly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine M Dell
- Pediatric Institute, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
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30
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Banerjee S, Kamath N, Antwi S, Bonilla-Felix M. Paediatric nephrology in under-resourced areas. Pediatr Nephrol 2022; 37:959-972. [PMID: 33839937 DOI: 10.1007/s00467-021-05059-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Nearly 50% of the world population and 60% of children aged 0 to 14 years live in low- or lower-middle-income countries. Paediatric nephrology (PN) in these countries is not a priority for allocation of limited health resources. This article explores advancements made and persisting limitations in providing optimal PN services to children in such under-resourced areas (URA). METHODS Medline, PubMed and Google Scholar online databases were searched for articles pertaining to PN disease epidemiology, outcome, availability of services and infrastructure in URA. The ISN and IPNA offices were contacted for data, and two online questionnaire surveys of IPNA membership performed. Regional IPNA members were contacted for further detailed information. RESULTS There is a scarcity of published data from URA; where available, prevalence of PN diseases, managements and outcomes are often reported to be different from high income regions. Deficiencies in human resources, fluoroscopy, nuclear imaging, immunofluorescence, electron microscopy and genetic studies were identified. Several drugs and maintenance kidney replacement therapy are inaccessible to the majority of patients. Despite these issues, regional efforts with support from international bodies have led to significant advances in PN services and infrastructure in many URA. CONCLUSIONS Equitable distribution and affordability of PN services remain major challenges in URA. The drive towards acquisition of regional data, advocacy to local government and non-government agencies and partnership with international support bodies needs to be continued. The aim is to optimise and achieve global parity in PN training, investigations and treatments, initially focusing on preventable and reversible conditions.
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Affiliation(s)
| | | | - Sampson Antwi
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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31
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De Bruyne E, Eloot S, Vande Walle J, Raes A, Van Biesen W, Goubert L, Vervoort T, Snauwaert E, Van Hoecke E. Validity and reliability of the Dutch version of the PedsQL™ 3.0 End Stage Renal Disease Module in children with chronic kidney disease in Belgium. Pediatr Nephrol 2022; 37:1087-1096. [PMID: 34599378 DOI: 10.1007/s00467-021-05224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) have a low quality of life (QoL). The PedsQL™ 4.0 Generic Core Scales are widely used to assess general QoL in children. The aim of this cross-sectional study was to translate the original version of the CKD-specific PedsQL™ 3.0 End Stage Renal Disease Module into a Dutch version and to evaluate its validity and reliability. METHODS The forward-backward translation method based on the guidelines from the original developer was used to produce the Dutch version of the PedsQL™ 3.0 ESRD Module. Fifty-eight CKD patients (aged 8-18 years) and their parents (n = 31) filled in both generic and disease-specific modules. The non-clinical control group consisted of the same number of healthy children (matched for gender and age) and their parents. RESULTS Cronbach's alpha coefficients (α's) for the PedsQL™ 3.0 ESRD Module demonstrated excellent reliability for the Total Scale scores. For all 7 subscales, α's were greater than 0.60, except for Perceived Physical Appearance. Overall, intercorrelations with the PedsQL™ 4.0 Generic Core Scales were in the medium to large range, supporting construct validity. Parent proxy reports showed lower generic QoL for all domains in CKD patients compared to healthy children. Child self-reports only demonstrated lower QoL on the domain School Functioning in children with CKD compared to healthy children. CONCLUSIONS This study shows good validity and reliability for the Dutch version of the PedsQL™ 3.0 ESRD Module. However, testing with a larger study group is recommended in order to make final conclusions about the psychometric qualities of this measure. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Elke De Bruyne
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
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Brown DD, Carroll M, Ng DK, Levy RV, Greenbaum LA, Kaskel FJ, Furth SL, Warady BA, Melamed ML, Dauber A. Longitudinal Associations between Low Serum Bicarbonate and Linear Growth in Children with CKD. KIDNEY360 2022; 3:666-676. [PMID: 35721607 PMCID: PMC9136912 DOI: 10.34067/kid.0005402021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
Background Poor linear growth is a consequence of chronic kidney disease (CKD) that has been linked to adverse outcomes. Metabolic acidosis (MA) has been identified as a risk factor for growth failure. We investigated the longitudinal relationship between MA and linear growth in children with CKD and examined whether treatment of MA modified linear growth. Methods To describe longitudinal associations between MA and linear growth, we used serum bicarbonate levels, height measurements, and standard deviation (z scores) of children enrolled in the prospective cohort study Chronic Kidney Disease in Children. Analyses were adjusted for covariates recognized as correlating with poor growth, including demographic characteristics, glomerular filtration rate (GFR), proteinuria, calcium, phosphate, parathyroid hormone, and CKD duration. CKD diagnoses were analyzed by disease categories, nonglomerular or glomerular. Results The study population included 1082 children with CKD: 808 with nonglomerular etiologies and 274 with glomerular etiologies. Baseline serum bicarbonate levels ≤22 mEq/L were associated with worse height z scores in all children. Longitudinally, serum bicarbonate levels ≤18 and 19-22 mEq/L were associated with worse height z scores in children with nonglomerular CKD causes, with adjusted mean values of -0.39 (95% CI, -0.58 to -0.2) and -0.17 (95% CI, -0.28 to -0.05), respectively. Children with nonglomerular disease and more severe GFR impairment had a higher risk for worse height z score. A significant association was not found in children with glomerular diseases. We also investigated the potential effect of treatment of MA on height in children with a history of alkali therapy use, finding that only persistent users had a significant positive association between their height z score and higher serum bicarbonate levels. Conclusions We observed a longitudinal association between MA and lower height z score. Additionally, persistent alkali therapy use was associated with better height z scores. Future clinical trials of alkali therapy need to evaluate this relationship prospectively.
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Affiliation(s)
- Denver D. Brown
- Division of Nephrology, Children’s National Hospital, Washington, DC
| | - Megan Carroll
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Derek K. Ng
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca V. Levy
- Division of Pediatric Nephrology, University of Rochester Medical Center, Rochester, New York
| | - Larry A. Greenbaum
- Division of Pediatric Nephrology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Frederick J. Kaskel
- Division of Pediatric Nephrology, The Children’s Hospital at Montefiore, Bronx, New York
| | - Susan L. Furth
- Division of Pediatric Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bradley A. Warady
- Division of Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Michal L. Melamed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Andrew Dauber
- Division of Endocrinology, Children’s National Hospital, Washington, DC
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The Use of Patient-Reported Outcome Measures in Daily Clinical Practice of a Pediatric Nephrology Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095338. [PMID: 35564731 PMCID: PMC9102002 DOI: 10.3390/ijerph19095338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: Health-related quality of life (HRQoL) is lower in patients with chronic kidney disease (CKD) compared to the general population. In 2011, the KLIK PROM portal was implemented in the Emma Children’s Hospital to monitor and discuss HRQoL in daily care. This study describes and assesses the implementation and use of the KLIK PROM portal in the pediatric nephrology department. (2) Methods: CKD patients (self-report, if 8–18 years of age) and their parents (proxy-report, if 1–8 years) were invited to complete HRQoL patient-reported outcome measures (PROMs): TNO-AZL Preschool children Quality Of Life (TAPQOL) or Pediatric Quality of Life Inventory for Children (PedsQL). The PROMs were completed before and discussed during outpatient consultations. The adaptation rate—the proportion of patients/parents who were invited and completed at least one PROM—was calculated. Reported HRQoL scores of CKD patients were compared to the general population. (3) Results: In total, 142 patients (proxy- and self-report) were invited, 112 patients completed at least one PROM (adaptation rate 79%). Patients (n = 84 with informed consent for scientific use) with CKD reported lower HRQoL and HRQoL was more often impaired compared to the general Dutch population. (4) Conclusions: The implementation of KLIK was successful and its use is feasible for daily care. Using KLIK, HRQoL problems can be easily identified and monitored.
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Hooper SR, Johnson RJ, Gerson AC, Lande MB, Shinnar S, Harshman LA, Kogon AJ, Matheson M, Bartosh S, Carlson J, Warady BA, Furth SL. Overview of the findings and advances in the neurocognitive and psychosocial functioning of mild to moderate pediatric CKD: perspectives from the Chronic Kidney Disease in Children (CKiD) cohort study. Pediatr Nephrol 2022; 37:765-775. [PMID: 34110493 PMCID: PMC8660930 DOI: 10.1007/s00467-021-05158-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
The Chronic Kidney Disease in Children (CKiD) prospective cohort study was designed to address the neurocognitive, growth, cardiovascular, and disease progression of children and adolescents with mild to moderate CKD. The study has had continuous funding from NIDDK for 17 years and has contributed significant advances in pediatric CKD. The goals of this educational review are threefold: (1) to provide an overview of the neurocognitive and psychosocial studies from CKiD to date; (2) to provide best practice recommendations for those working with the neurocognitive and psychosocial aspects of pediatric CKD based on CKiD findings; and (3) to help chart future goals and directives for both research and clinical practice. This collection of 22 empirical studies has produced a number of key findings for children and adolescents with mild to moderate CKD. While various studies suggest a relatively positive presentation for this population as a whole, without evidence of significant impairment or deterioration, findings do indicate the presence of neurocognitive dysfunction, emotional-behavioral difficulties, and lower quality of life for many children with CKD. These findings support the promotion of best practices that are accompanied by additional future clinical and research initiatives with this patient population.
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Affiliation(s)
- Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
| | - Rebecca J Johnson
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA
| | - Arlene C Gerson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marc B Lande
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lyndsay A Harshman
- Division of Pediatric Nephrology, University of Iowa Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Amy J Kogon
- Children's Hospital of Philadelphia, Division of Pediatric Nephrology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Matheson
- Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sharon Bartosh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joann Carlson
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Susan L Furth
- Children's Hospital of Philadelphia, Division of Pediatric Nephrology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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35
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Brown DD, Dauber A. Growth Hormone and Insulin-Like Growth Factor Dysregulation in Pediatric Chronic Kidney Disease. Horm Res Paediatr 2022; 94:105-114. [PMID: 34256372 DOI: 10.1159/000516558] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
Poor growth is a common finding in children with chronic kidney disease (CKD) that has been associated with poor long-term outcomes. The etiology of poor growth in this population is multifactorial and includes dysregulation of the growth hormone (GH) and insulin-like growth factor (IGF) axis. In this review, we describe the data on GH resistance or insensitivity and inappropriate levels or reduced bioactivity of IGF proposed as contributing factors of growth impairment in children with CKD. Additionally, we describe the theorized negative effect of metabolic acidosis, another frequent finding in pediatric CKD, on the GH/IGF axis and growth. Last, we present the current and potential therapies for the treatment of short stature in pediatric CKD that target the GH/IGF hormonal axis.
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Affiliation(s)
- Denver D Brown
- Division of Nephrology, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Andrew Dauber
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.,Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA
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36
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Feng Z, Lu K, Ma Y, Liu F, Zhang X, Li H, Fu Y. Effect of a high vs. standard dose of vitamin D3 supplementation on bone metabolism and kidney function in children with chronic kidney disease. Front Pediatr 2022; 10:990724. [PMID: 36405836 PMCID: PMC9673817 DOI: 10.3389/fped.2022.990724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
We investigated the effects of high- vs. standard-dose vitamin D supplementation on kidney function and bone metabolism in children with chronic kidney disease (CKD). Children were randomized to receive one of two formulations: 75 participants received 2,000 IU/D of oral supplementation of vitamin D, while 75 participants received 400 IU/d for a minimum of 4 months. We investigated the effects of vitamin D supplementation on kidney-related indicators and bone metabolism-related indicators at different doses. A total of 158 participants were screened, among whom 150 met the inclusion criteria. The indicators of chronic kidney disease such as eGFR and serum uric acid were negatively correlated with the 25(OH)D level and BMD. Serum 25(OH)D and osteocalcin levels were positively correlated with spine BMD. The standard dose of vitamin D can improve the serum uric acid level, but high doses of vitamin D supplementation had no significant effect on the serum uric acid level. High doses of vitamin D supplementation can also improve the alkaline phosphatase level. When comparing the results of different doses of vitamin D supplementation, it was found that high-dose vitamin D supplementation did not improve bone density in the spine and femur neck relative to the standard dose of vitamin D but improved hypocalcemia and N-terminal propeptide of the human procollagen type I (PINP) level. Among the children with clinical kidney disease, high-dose vitamin D treatment for 4 months resulted in statistically significant improvement in kidney function but no significant difference in bone metabolism compared with the standard-dose vitamin D treatment.
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Affiliation(s)
- Zhiqiang Feng
- Department of Pediatric Surgery, Taian Maternal and Child Health-Care Hospital, Tai'an, China
| | - Kunna Lu
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yan Ma
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Feng Liu
- Department of Surgery, Taian City Central Hospital, Tai'an, China
| | - Xinhuan Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Hongxiang Li
- Department of Neonatal Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yan Fu
- The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
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Greenberg JH, Abraham AG, Xu Y, Schelling JR, Feldman HI, Sabbisetti VS, Ix JH, Jogalekar MP, Coca S, Waikar SS, Shlipak MG, Warady BA, Vasan RS, Kimmel PL, Bonventre JV, Denburg M, Parikh CR, Furth S. Urine Biomarkers of Kidney Tubule Health, Injury, and Inflammation are Associated with Progression of CKD in Children. J Am Soc Nephrol 2021; 32:2664-2677. [PMID: 34544821 PMCID: PMC8722795 DOI: 10.1681/asn.2021010094] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/28/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Novel urine biomarkers may improve identification of children at greater risk of rapid kidney function decline, and elucidate the pathophysiology of CKD progression. METHODS We investigated the relationship between urine biomarkers of kidney tubular health (EGF and α-1 microglobulin), tubular injury (kidney injury molecule-1; KIM-1), and inflammation (monocyte chemoattractant protein-1 [MCP-1] and YKL-40) and CKD progression. The prospective CKD in Children Study enrolled children aged 6 months to 16 years with an eGFR of 30-90ml/min per 1.73m2. Urine biomarkers were assayed a median of 5 months [IQR: 4-7] after study enrollment. We indexed the biomarker to urine creatinine by dividing the urine biomarker concentration by the urine creatinine concentration to account for the concentration of the urine. The primary outcome was CKD progression (a composite of a 50% decline in eGFR or kidney failure) during the follow-up period. RESULTS Overall, 252 of 665 children (38%) reached the composite outcome over a median follow-up of 6.5 years. After adjustment for covariates, children with urine EGF concentrations in the lowest quartile were at a seven-fold higher risk of CKD progression versus those with concentrations in the highest quartile (fully adjusted hazard ratio [aHR], 7.1; 95% confidence interval [95% CI], 3.9 to 20.0). Children with urine KIM-1, MCP-1, and α-1 microglobulin concentrations in the highest quartile were also at significantly higher risk of CKD progression versus those with biomarker concentrations in the lowest quartile. Addition of the five biomarkers to a clinical model increased the discrimination and reclassification for CKD progression. CONCLUSIONS After multivariable adjustment, a lower urine EGF concentration and higher urine KIM-1, MCP-1, and α-1 microglobulin concentrations were each associated with CKD progression in children.
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Affiliation(s)
- Jason H. Greenberg
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut,Department of Medicine Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yunwen Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeffrey R. Schelling
- Department of Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Harold I. Feldman
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Manasi P. Jogalekar
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Steven Coca
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sushrut S. Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Michael G. Shlipak
- UCSF Division of General Internal Medicine at the VA, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California
| | - Bradley A. Warady
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Ramachandran S. Vasan
- Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Paul L. Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Joseph V. Bonventre
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michelle Denburg
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chirag R. Parikh
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, New York
| | - Susan Furth
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Incidence of and risk factors for short stature in children with chronic kidney disease: results from the KNOW-Ped CKD. Pediatr Nephrol 2021; 36:2857-2864. [PMID: 33786659 DOI: 10.1007/s00467-021-05054-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preserving optimal growth has long been a significant concern for children with chronic kidney disease (CKD). We aimed to examine the incidence of and risk factors for short stature in Asian pediatric patients with CKD. METHODS We analyzed growth status by height, weight, and body mass index (BMI) standard deviation scores (SDSs) for 432 participants in the KoreaN cohort study for Outcome in patients With Pediatric Chronic Kidney Disease. RESULTS The median height, weight, and BMI SDSs were - 0.94 (interquartile range (IQR) - 1.95 to 0.05), - 0.58 (IQR - 1.46 to 0.48), and - 0.26 (IQR - 1.13 to 0.61), respectively. A high prevalence of short stature (101 of 432 patients, 23.4%) and underweight (61 of 432 patients, 14.1%) was observed. In multivariable logistic regression analysis, CKD stages 4 and 5 (adjusted odds ratio (aOR) 2.700, p = 0.001), onset before age 2 (aOR 2.928, p < 0.0001), underweight (aOR 2.353, p = 0.013), premature birth (aOR 3.484, p < 0.0001), LBW (aOR 3.496, p = 0.001), and low household income (aOR 1.935, p = 0.030) were independent risk factors associated with short stature in children with CKD. CONCLUSIONS Children with CKD in Korea were shorter and had lower body weight and BMI than the general population. Short stature in children with CKD was most independently associated with low birth weight, followed by premature birth, onset before age 2, CKD stages 4 and 5, underweight, and low household income. Among these, underweight is the only modifiable factor. Therefore, we suggest children with CKD should be carefully monitored for weight, nutritional status, and body composition to achieve optimal growth.
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Nunes S, Hessey E, Dorais M, Perreault S, Jouvet P, Phan V, Lacroix J, Lafrance JP, Samuel S, Zappitelli M. Association of pediatric cardiac surgery-associated acute kidney injury with post-discharge healthcare utilization, mortality and kidney outcomes. Pediatr Nephrol 2021; 36:2865-2874. [PMID: 33770283 DOI: 10.1007/s00467-021-04999-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/18/2021] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute kidney Injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with hospital morbidity. Post-discharge CS AKI outcomes are less clear. We evaluated associations between AKI and post-discharge (a) healthcare utilization, (b) chronic kidney disease (CKD) or hypertension and (c) mortality. METHODS This is a retrospective two-centre cohort study of children surviving to hospital discharge after CS. Primary exposures were post-operative ≥Stage 1 AKI and ≥Stage 2 AKI defined by Kidney Disease Impoving Global Outcomes. Association of AKI with time to outcomes was determined using multivariable Cox-Proportional Hazards analysis. RESULTS Of 350 participants included (age 3.1 (4.5) years), 180 [51.4%] developed AKI and 60 [17.1%] developed ≥Stage 2 AKI. Twenty-eight (9%) participants developed CKD or hypertension (composite outcome), and 17 (5%) died within 5 years of discharge. Post-operative ≥Stage 1 and ≥Stage 2 AKI were not associated with post-discharge hospitalizations, emergency room (ER) visits, physician visits or CKD or hypertension in adjusted analyses. A trend was observed between ≥Stage 2 AKI and mortality but was not statistically significant. In unadjusted stratified analyses, AKI was associated with post-discharge hospitalizations in children with RACHS-1 score ≥3, complex chronic disease classification and children living in urban areas. CONCLUSIONS Post-CS AKI is not associated with post-discharge healthcare utilization, death and CKD or hypertension, though it may be associated with healthcare utilization in more complex paediatric CS children. Studies should aim to better understand post-CS healthcare utilization patterns and non-AKI risk factors for CKD, hypertension and mortality, to reduce adverse long-term outcomes after CS.
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Affiliation(s)
- Sophia Nunes
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St. 11th Floor, Room 11.9722, Toronto, Ontario, Canada
| | - Erin Hessey
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St. 11th Floor, Room 11.9722, Toronto, Ontario, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-I'Île-Perrot, Canada
| | | | - Philippe Jouvet
- Department of Pediatrics, Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Véronique Phan
- Department of Pediatrics, Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | | | - Susan Samuel
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Michael Zappitelli
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St. 11th Floor, Room 11.9722, Toronto, Ontario, Canada. .,Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Canada.
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Ruidiaz-Gómez KS, Higuita-Gutiérrez LF. Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis. J Pediatr (Rio J) 2021; 97:478-489. [PMID: 33340460 PMCID: PMC9432262 DOI: 10.1016/j.jped.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument. SOURCES OF DATA A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out. SUMMARY OF THE FINDINGS 17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3-5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the physical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points. CONCLUSION The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the "school" dimension being the most affected and the "emotional" one the least. In this sense, we suggest monitoring the health-related quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease.
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Affiliation(s)
- Keydis Sulay Ruidiaz-Gómez
- University of Antioquia, Faculty of Nursing, Medellin, Colombia; Sinú University Elías Bechara Zainúm, Nursing Program, Cartagena, Colombia.
| | - Luis Felipe Higuita-Gutiérrez
- Cooperative University of Colombia, Faculty of Medicine, Medellin, Colombia; University of Antioquia, School of Microbiology, Medellin, Colombia
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Chronic Kidney Disease-Associated Itch (CKD-aI) in Children-A Narrative Review. Toxins (Basel) 2021; 13:toxins13070450. [PMID: 34209560 PMCID: PMC8309841 DOI: 10.3390/toxins13070450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic kidney disease (CKD) is a condition of widespread epidemiology and serious consequences affecting all organs of the organism and associated with significant mortality. The knowledge on CKD is rapidly evolving, especially concerning adults. Recently, more data is also appearing regarding CKD in children. Chronic itch (CI) is a common symptom appearing due to various underlying dermatological and systemic conditions. CI may also appear in association with CKD and is termed chronic kidney disease-associated itch (CKD-aI). CKD-aI is relatively well-described in the literature concerning adults, yet it also affects children. Unfortunately, the data on paediatric CKD-aI is particularly scarce. This narrative review aims to describe various aspects of CKD-aI with an emphasis on children, based on the available data in this population and the data extrapolated from adults. Its pathogenesis is described in details, focusing on the growing role of uraemic toxins (UTs), as well as immune dysfunction, altered opioid transmission, infectious agents, xerosis, neuropathy and dialysis-associated aspects. Moreover, epidemiological and clinical aspects are reviewed based on the few data on CKD-aI in children, whereas treatment recommendations are proposed as well, based on the literature on CKD-aI in adults and own experience in managing CI in children.
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Health-related quality of life in children with chronic kidney disease is affected by the number of medications. Pediatr Nephrol 2021; 36:1307-1310. [PMID: 33547529 PMCID: PMC8935420 DOI: 10.1007/s00467-021-04919-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/23/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The number of medications could serve as a surrogate for burden of care at home and may affect health-related quality of life (HRQoL) in children with chronic kidney disease (CKD). METHODS Using baseline data from the Chronic Kidney Disease in Children (CKiD) Study, we modeled HRQoL scores, self-reported by the child (if ≥ 8 years old) and/or caregiver (all children) on unique counts and administrations of CKD- and non-CKD-related medications, using multivariate linear regression. Heterogeneity of associations between HRQoL and medication burden by age group (≥ 8 vs. < 8 years old) were explored. RESULTS 734 participants median age 11 years, disease duration 8 years, median eGFR 53 mL/min/1.73 m2, 61% male, 22% African-American, 31% glomerular disease were prescribed median 3 unique CKD-related medications. Regarding HRQoL assessment, 201 children were < 8 years old and had only parent-proxy HRQoL score; 533 children ≥ 8 years of age had both child and parent-proxy scores. Overall, parents of children < 8 years old reported higher HRQoL scores than parents of older children: 84 vs. 76. However, in a unified multivariate regression model, HRQoL scores of children < 8 years showed greater decreases as the number of CKD-related medications increased compared to scores for children ≥ 8 years old. CONCLUSION Average HRQoL scores reported by parents of younger CKD children were higher than those of older CKD children but decreased more with increased CKD medication counts than scores of older children. Considerations of HRQoL may be of particular importance for clinicians and caregivers when managing chronic disease comorbidities in younger children.
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Backeljauw P, Cappa M, Kiess W, Law L, Cookson C, Sert C, Whalen J, Dattani MT. Impact of short stature on quality of life: A systematic literature review. Growth Horm IGF Res 2021; 57-58:101392. [PMID: 33975197 DOI: 10.1016/j.ghir.2021.101392] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We sought to obtain a better understanding of the burden of short stature using a systematic literature review. METHODS Studies of the burden of short stature, of any cause in adults and children, were searched using Embase, MEDLINE and Cochrane databases in April 2020, capturing publications from 2008 onwards. Case series and populations with adult-onset growth hormone deficiency (GHD) were excluded. RESULTS Of 1684 publications identified, 41 studies (33 in children, 8 in adults) were included. All studies assessed human burden. Most study populations in children included short stature due to GHD, idiopathic short stature (ISS) and short stature after being born small for gestational age (SGA). In these populations, four studies showed that quality of life (QoL) in children with short stature was significantly worse than in children with normal stature. A significant association between QoL and short stature was observed in children with chronic kidney disease (CKD) (3 studies), achondroplasia (1 study) and transfusion-dependent β-thalassaemia (1 study), and in samples with mixed causes of short stature (3 studies). Three studies (one in GHD/ISS/SGA and two in CKD) found no significant association between short stature and QoL, and several studies did not report statistical significance. Approximately half of adult studies showed that QoL was reduced with short stature, and the other half showed no association. Two studies, one in adults with Prader-Willi syndrome and one in children with GHD, suggested a potential association between short stature and poorer cognitive outcomes. Three studies demonstrated an increased caregiver burden in parents of children with short stature. CONCLUSIONS Evidence suggests that, compared with those with normal stature, children and adults with short stature of any cause may experience poorer QoL. Further research could extend our understanding of the human burden in this field.
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Affiliation(s)
- Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Marco Cappa
- Bambino Gesù Children's Hospital, Rome, Italy
| | - Wieland Kiess
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Lisa Law
- Oxford PharmaGenesis, Oxford, UK
| | | | | | | | - Mehul T Dattani
- UCL Great Ormond Street Institute of Child Health, London, UK
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Diaz-Gonzalez de Ferris ME, Díaz-González de Martínez MDL, Díaz-González de Velázquez AM, Díaz-González Borja A, Díaz-González Borja A, Filler G, Alvarez-Elías AC, Díaz-González Borja V. An Interdisciplinary Approach to Optimize the Care of Transitioning Adolescents and Young Adults with CKD. Blood Purif 2021; 50:684-695. [PMID: 33706317 DOI: 10.1159/000513520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022]
Abstract
Adolescents and young adults (AYAs) with CKD or end-stage kidney disease (ESKD) have unique medical, dental, psychosocial, neurocognitive, and academic needs and require close interdisciplinary collaboration to optimize their care. The etiology of CKD in AYAs is diverse compared to older adults. With their continuously improved survival, AYAs must start preparation for health-care transition (HCT) from pediatric- to adult-focused health care in the pediatric setting and it must continue at the adult-focused setting, given that their brain maturation and self-management skill acquisition occur until their mid-20s. While the growth and physical maturation of most visible body parts occur before 18 years of age, the prefrontal cortex of the brain, where reasoning, impulse control, and other higher executive functions reside, matures around 25 years of age. The HCT process must be monitored using patient- and caregiver-measuring tools to guide interventions. The HCT process becomes more complex when patients and/or caregivers have a language barrier, different cultural beliefs, or lower literacy levels. In this article, we discuss the unique comorbidities of pediatric-onset CKD/ESKD, provide information for a planned HCT preparation, and suggest interdisciplinary coordination as well as cultural and literacy-appropriate activities to achieve optimal patient outcomes.
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Affiliation(s)
| | - María de Lourdes Díaz-González de Martínez
- Escuela de Biotecnología, Universidad Mexicana del Estado de Mexico (UNIMEX), Mexico City, Mexico.,Ciencias de la Salud y Metodología de la Investigación, Escuela Preparatoria Oficial Anexa a la Normal de Cuautitlán-Izacalli, Estado de México, Mexico
| | | | | | | | - Guido Filler
- Departments of Paediatrics, University of Western Ontario, London, Ontario, Canada.,Departments of Medicine, University of Western Ontario, London, Ontario, Canada.,Departments of Pathology & Laboratory Medicine, University of Western Ontario, London, Ontario, Canada.,Lilibeth Caberto Kidney Clinical Research Unit, London, Ontario, Canada
| | - Ana Catalina Alvarez-Elías
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Unidad de Investigación y Diagnóstico en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico.,Unidad de Estudios de Posgrado, Universidad Nacional Autónoma de, Mexico City, Mexico
| | - Vicente Díaz-González Borja
- San Ysidro Health, San Diego, California, USA.,Department of Medicine, Universidad Autónoma de Guadalajara, Guadalajara, Mexico
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Kerklaan J, Hannan E, Baumgart A, Manera KE, Ju A, McCulloch M, Admani B, Dominello A, Esezobor C, Foster B, Hamilton A, Jankauskiene A, Johnson RJ, Liu I, Marks SD, Neu A, Schaefer F, Sutton S, Wolfenden S, Craig JC, Groothoff J, Howell M, Tong A. Patient- and parent proxy-reported outcome measures for life participation in children with chronic kidney disease: a systematic review. Nephrol Dial Transplant 2021; 35:1924-1937. [PMID: 32743664 DOI: 10.1093/ndt/gfaa132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The burden of chronic kidney disease (CKD) and its treatment may severely limit the ability of children with CKD to do daily tasks and participate in family, school, sporting and recreational activities. Life participation is critically important to affected children and their families; however, the appropriateness and validity of available measures used to assess this outcome are uncertain. The aim of this study was to identify the characteristics, content and psychometric properties of existing measures for life participation used in children with CKD. METHODS We searched MEDLINE, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Kidney and Transplant register to August 2019 for all studies that used a measure to report life participation in children with CKD. For each measure, we extracted and analyzed the characteristics, dimensions of life participation and psychometric properties. RESULTS From 128 studies, we identified 63 different measures used to assess life participation in children with CKD. Twenty-five (40%) of the measures were patient reported, 7 (11%) were parent proxy reported and 31 (49%) had both self and parent proxy reports available. Twenty-two were used in one study only. The Pediatric Quality of Life Inventory version 4.0 generic module was used most frequently in 62 (48%) studies. Seven (11%) were designed to assess ability to participate in life, with 56 (89%) designed to assess other constructs (e.g. quality of life) with a subscale or selected questions on life participation. Across all measures, the three most frequent activities specified were social activities with friends and/or family, leisure activities and self-care activities. Validation data in the pediatric CKD population were available for only 19 (30%) measures. CONCLUSIONS Life participation is inconsistently measured in children with CKD and the measures used vary in their characteristics, content and validity. Validation data supporting these measures in this population are often incomplete and are sparse. A meaningful and validated measure for life participation in children with CKD is needed.
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Affiliation(s)
- Jasmijn Kerklaan
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Elyssa Hannan
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Karine E Manera
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Bashir Admani
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Amanda Dominello
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Christopher Esezobor
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Bethany Foster
- Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital of the McGill University Health Centre, Montreal, QB, Canada
| | | | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Rebecca J Johnson
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Isaac Liu
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Alicia Neu
- Division of Pediatric Nephrology, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Shanna Sutton
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Wolfenden
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
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Ofori-Ansah S, Evans M, Jones J, Thomas N. Decision-making experiences of young adults with long-term conditions. J Ren Care 2021; 48:24-40. [PMID: 33665963 DOI: 10.1111/jorc.12367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/21/2020] [Accepted: 01/22/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Young adults with long-term conditions can struggle to accept their diagnosis and can become overwhelmed with managing their condition. Suboptimal transfer from paediatric to adult services with a resultant disengagement with the service can result in less involvement in care and decision-making. Shared decision-making can improve involvement in health decisions and increase satisfaction with treatment/therapy and care. OBJECTIVES An integrative literature review was conducted to explore and understand young adults' experiences of decision-making in health care. DESIGN An integrative literature review. DATA SOURCES CINAHL, EMCARE, PsycINFO, HMIC, EMBASE, Web of Science, PubMed, MEDLINE, EBSCOHOST and COCHRANE databases were searched for relevant literature published between January 1999 and January 2020. FINDINGS Thirteen primary research papers met the inclusion criteria. Four main themes were identified: (1) Information delivery and communication; (2) participation in decision-making; (3) social factors influencing decision-making and (4) emotional impact of decision-making. CONCLUSIONS Young adults with long-term conditions have specific decision-making needs which can impact their emotional health. Research with a specific focus on young adults' experiences of decision-making in health care is needed.
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Affiliation(s)
- Sarah Ofori-Ansah
- School of Health and Social Care, London South Bank University, London, UK
| | - Michelle Evans
- School of Health and Social Care, London South Bank University, London, UK
| | - Janice Jones
- School of Health and Social Care, London South Bank University, London, UK
| | - Nicola Thomas
- School of Health and Social Care, London South Bank University, London, UK
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Chronic kidney disease impacts health-related quality of life of children in Uganda, East Africa. Pediatr Nephrol 2021; 36:323-331. [PMID: 32737578 DOI: 10.1007/s00467-020-04705-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Limited data exist about causes of chronic kidney disease (CKD) and impact on health-related quality of life (HRQoL) in African children. We evaluated types of kidney disease in Ugandan children 0-18 years and compared HRQoL in children with CKD or with benign or resolving kidney disease (non-CKD) to assess predictors of HRQoL. METHODS Demographic, socioeconomic, and clinical data were obtained for this cross-sectional study. Pediatric Quality of Life Core Scale™ (PedsQL) was used to survey 4 domains and overall HRQoL. CKD and non-CKD scores were compared using unpaired t test. HRQoL predictors were evaluated using linear and logistic regression analyses. RESULTS One hundred forty-nine children (71 CKD, 78 non-CKD; median age 9 years; male 63%) had the following primary diseases: nephrotic syndrome (56%), congenital anomalies of the urinary tract (CAKUT) (19%), glomerulonephritis (17%), and other (8%). CAKUT was the predominant etiology (39%) for CKD; 63% had advanced stages 3b-5. Overall HRQoL scores were significantly lower for CKD (57 vs. 86 by child report, p < 0.001; 63 vs. 86 by parent proxy report, p < 0.001). Predictors of lower HRQoL were advanced CKD stages 3b-5, primary caregiver non-parent, vitamin D deficiency, and anemia. CONCLUSION Like other parts of the world, CAKUT was the main cause of CKD. Most CKD children presented at late CKD stages 3b-5. Compared with non-CKD, HRQoL in CKD was much lower; only two-thirds attended school. Vitamin D deficiency and anemia were potentially modifiable predictors of low HRQoL. Interventions with vitamin D, iron, and erythropoietin-stimulating agents might lead to improved HRQoL.
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Mizerska-Wasiak M, Adamczuk D, Cichoń-Kawa K, Miklaszewska M, Szymanik-Grzelak H, Pietrzyk JA, Pukajło-Marczyk A, Zwolińska D, Rybi-Szumińska A, Wasilewska A, Bieniaś B, Sikora P, Firszt-Adamczyk A, Stankiewicz R, Szczepańska M, Pańczyk-Tomaszewska M. Health-related quality of life in children with immunoglobulin A nephropathy - results of a multicentre national study. Arch Med Sci 2021; 17:84-91. [PMID: 33488859 PMCID: PMC7811315 DOI: 10.5114/aoms.2020.100367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/07/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Immunoglobulin A nephropathy (IgAN) may lead to end stage renal disease and severely affect patient functioning and wellbeing. The aim of the study was to evaluate health-related quality of life (HRQoL) in children and adolescents with IgAN, and compare HRQoL in relation to the disease course, social status and psychological factors, such as expressing anger and perceived personal competence. MATERIAL AND METHODS The multicentre cross-sectional study included 51 patients ≥ 8 years from 7 paediatric nephrology centres in Poland. Psychometric analysis was performed using the Kidscreen-52 questionnaire to evaluate HRQoL, the Anger Expression Scale to evaluate the severity of anger and the Personal Competence Scale to measure general perception of personal competence. RESULTS Mean age of patients was 14.54 ±3.69 years; duration since the diagnosis of IgAN was 4.98 ±3.9 years. Patients with IgAN rated their psychological wellbeing as significantly worse compared to healthy peers (p < 0.05). The presence of proteinuria was associated with significantly worse physical wellbeing (58.72 ±18.45 vs. 74.44 ±22.97; p < 0.05). Current therapy (steroids/immunosuppressive drugs) had no effect on HRQoL in the study group. Perceived personal competence was rated high by 49% of children in the study group. Children with IgAN were characterized by lower intensity of expressed anger (p < 0.001) and significantly higher intensity of suppressed anger (p < 0.01) compared to reference ranges. Severity of expressed anger correlated positively with the parent relations and school environment dimensions of HRQoL. CONCLUSIONS We found lower HRQoL in regard to physical and psychological wellbeing in a group of Polish children with IgAN compared to healthy peers. HRQoL should be monitored in this patient group.
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Affiliation(s)
| | - Dominika Adamczuk
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Cichoń-Kawa
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Miklaszewska
- Department of Paediatric Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Jacek A. Pietrzyk
- Department of Paediatric Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Danuta Zwolińska
- Department and Clinic of Paediatric Nephrology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland
| | - Beata Bieniaś
- Department of Paediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Sikora
- Department of Paediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | | | - Roman Stankiewicz
- Department of Paediatric Nephrology, Provincial Polyclinical Hospital, Torun, Poland
| | - Maria Szczepańska
- Department of Paediatric Nephrology, Medical University of Silesia, Katowice, Poland
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Plumb L, Boother EJ, Caskey FJ, Sinha MD, Ben-Shlomo Y. The incidence of and risk factors for late presentation of childhood chronic kidney disease: A systematic review and meta-analysis. PLoS One 2020; 15:e0244709. [PMID: 33382793 PMCID: PMC7774987 DOI: 10.1371/journal.pone.0244709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When detected early, inexpensive measures can slow chronic kidney disease progression to kidney failure which, for children, confers significant morbidity and impacts growth and development. Our objective was to determine the incidence of late presentation of childhood chronic kidney disease and its associated risk factors. METHODS We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library and CINAHL, grey literature and registry websites for observational data describing children <21 years presenting to nephrology services, with reference to late presentation (or synonyms thereof). Independent second review of eligibility, data extraction, and risk of bias was undertaken. Meta-analysis was used to generate pooled proportions for late presentation by definition and investigate risk factors. Meta-regression was undertaken to explore heterogeneity. RESULTS Forty-five sources containing data from 30 countries were included, comprising 19,339 children. Most studies (37, n = 15,772) described children first presenting in kidney failure as a proportion of the chronic kidney disease population (mean proportion 0.43, 95% CI 0.34-0.54). Using this definition, the median incidence was 2.1 (IQR 0.9-3.9) per million age-related population. Risk associations included non-congenital disease and older age. Studies of hospitalised patients, or from low- or middle-income countries, that had older study populations than high-income countries, had higher proportions of late presentation. CONCLUSIONS Late presentation is a global problem among children with chronic kidney disease, with higher proportions seen in studies of hospitalised children or from low/middle-income countries. Children presenting late are older and more likely to have non-congenital kidney disease than timely presenting children. A consensus definition is important to further our understanding and local populations should identify modifiable barriers beyond age and disease to improve access to care.
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Affiliation(s)
- Lucy Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- UK Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Emily J. Boother
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Sezer TA, Çavuşoğlu H, Düzova A. Self-management program for adolescents with chronic kidney disease: A randomized controlled trial. J Ren Care 2020; 47:146-159. [PMID: 33373118 DOI: 10.1111/jorc.12357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is important to develop self-management behaviours in adolescents to prevent chronic kidney disease progression. OBJECTIVES This study evaluates the effect of a self-management program that was developed based on individual and family self-management theory to aid adolescents with chronic kidney disease in the acquisition of competencies in the management of their disease. DESIGN This is a randomized controlled study. PARTICIPANTS The study was conducted with 20 intervention and 20 control patients, who were treated at two hospitals in Ankara between December 2018 and May 2019. MEASUREMENTS Self-Management Assessment Form, Paediatric Quality of Life Inventory-Adolescent Form and clinical parameters. A training program, specific to chronic kidney disease, was administered over three sessions in a group training setting when the patients came to the clinic for follow-up. After the training program was completed, the patients were monitored for three months through home visits once every two weeks, totalling six visits. RESULTS Following the application of self-management training, a statistically significant difference was found self-management knowledge and behaviours, quality of life and anxiety mean scores of intervention and control group (p <.05), a significant decrease in only blood urea nitrogen among the clinical parameters when compared to the control group. CONCLUSIONS In this study, a self-management training program was developed based on Individual and Family Self-Management Theory, aiming to have a positive effect on the self-management behaviours of adolescents in the cognitive and psychosocial domains.
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Affiliation(s)
- Tufan Aslı Sezer
- Nursing Department, Faculty of Nursing, Ankara University, Ankara, Turkey
| | - Hicran Çavuşoğlu
- Head of Pediatric Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Ali Düzova
- Department of Pediatric Nephrology, İhsan Doğramacı Children Hospital, Hacettepe University, Ankara, Turkey
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