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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hudson AC, van Zwieten A, Mallitt KA, Durkan A, Hahn D, Guha C, Khalid R, Didsbury M, Francis A, McTaggart S, Mackie FE, Prestidge C, Teixeira-Pinto A, Lah S, Howell M, Howard K, Nassar N, Jaure A, Craig JC, Wong G, Kim S. School attendance and sport participation amongst children with chronic kidney disease: a cross-sectional analysis from the Kids with CKD (KCAD) study. Pediatr Nephrol 2024; 39:1229-1237. [PMID: 37945915 PMCID: PMC10899305 DOI: 10.1007/s00467-023-06198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND School attendance and life participation, particularly sport, is a high priority for children with chronic kidney disease (CKD). This study is aimed at assessing the association between CKD stage, sports participation, and school absences in children with CKD. METHODS Using data from the binational Kids with CKD study (ages 6-18 years, n = 377), we performed multivariable regression to evaluate the association between CKD stage, school absences, and sports participation. RESULTS Overall, 62% of participants played sport with the most frequent sport activities engaged in being swimming (17%) and soccer (17%). Compared to children with CKD 1-2, the incidence rate ratios (IRR) (95% CI) for sports participation amongst children with CKD 3-5, dialysis, or transplant were 0.84 (0.64-1.09), 0.59 (0.39-0.90), and 0.75 (0.58-0.96), respectively. The median (IQR) days of school absences within a four-week period were 1 day (0-1), with children on dialysis reporting the highest number of school absences (9 days (5-15)), followed by transplant recipients (2 days (1-7)), children with CKD 3-5 (1 day (0-3)), and with CKD 1-2 (1 day (0-3)). Duration of CKD modified the association between CKD stage and school absences, with children with a transplant experiencing a higher number of missed school days with increasing duration of CKD, but not in children with CKD 1-5 or on dialysis (p-interaction < 0.01). CONCLUSIONS Children receiving dialysis and with a kidney transplant had greater school absences and played fewer sports compared to children with CKD stages 1-2. Innovative strategies to improve school attendance and sport participation are needed to improve life participation of children with CKD.
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Affiliation(s)
- Adam C Hudson
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anita van Zwieten
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kylie-Ann Mallitt
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne Durkan
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Department of Nephrology, The Children's Hospital at Westmead, Westmead, Australia
| | - Deirdre Hahn
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Department of Nephrology, The Children's Hospital at Westmead, Westmead, Australia
| | - Chandana Guha
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Rabia Khalid
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Madeleine Didsbury
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anna Francis
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Child & Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Steven McTaggart
- Child & Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Fiona E Mackie
- Department of Nephrology, Sydney Children's Hospital at Randwick, Sydney, Australia
| | - Chanel Prestidge
- Department of Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Martin Howell
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Allison Jaure
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Road, Westmead, NSW, 2145, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.
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3
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Rohner K, Marlais M, Ahn YH, Ali A, Alsharief A, Novak AB, Brambilla M, Cakici EK, Candan C, Canpolat N, Yu-Hin Chan E, Decramer S, Didsbury M, Durao F, Durkan AM, Düzova A, Forbes T, Gracchi V, Güngör T, Horinouchi T, Demir BK, Kobayashi Y, Koskela M, Kurt-Sukur ED, La Scola C, Langan D, Li X, Malgieri G, Mastrangelo A, Min J, Mizerska-Wasiak M, Moussaoui N, Noyan A, Nuutinen M, O'Gormon J, Okamoto T, Oni L, Oosterveld M, Pańczyk-Tomaszewska M, Parmaksiz G, Pasini A, Rianthavorn P, Roelofs J, Shen Y, Sinha R, Topaloglu R, Torres DD, Udagawa T, Wennerström M, Yap YC, Tullus K. Outcome of immunosuppression in children with IgA vasculitis-related nephritis. Nephrol Dial Transplant 2024:gfae009. [PMID: 38211969 DOI: 10.1093/ndt/gfae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS IgA vasculitis with nephritis (IgAVN) is the most common vasculitis in children. Treatment recommendations are, due to a lack of evidence, based on expert opinion resulting in variation. The aim of this study was to describe clinical presentation, treatment and outcome of an extremely large cohort of children with biopsy proven IgAVN to identify prognostic risk factors and signals of treatment efficacy. METHODS Retrospective data were collected on 1148 children with biopsy proven IgAVN between 2005 and 2019 from 41 international paediatric nephrology centres across 25 countries and analyzed using multivariate analysis. The primary outcome was estimated glomerular filtration rate (eGFR) and persistent proteinuria at last follow up. RESULTS The median follow up was 3.7 years (IQR 2-6.2). At last follow up, 29% of patients had an eGFR < 90 ml/min/1.73m2, 36% had proteinuria and 3% had chronic kidney disease stage 4-5. Older age, lower eGFR at onset, hypertension and histological features of tubular atrophy and segmental sclerosis were predictors of poor outcome. There was no evidence to support any specific second line immunosuppressive regimen to be superior to others, even when further analysing subgroups of children with reduced kidney function, nephrotic syndrome or hypoalbuminemia at onset. Delayed start of immunosuppressive treatment was associated with a lower eGFR at last follow up. CONCLUSION In this large retrospective cohort, key features associated with disease outcome are highlighted. Importantly there was no evidence to support that any specific immunosuppressive treatments were superior to others. Further discovery science and well-conducted clinical trials are needed to define accurate treatment and improve outcomes of IgAVN.
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Affiliation(s)
- Katharina Rohner
- Department of Pediatric Nephrology, University Children's Hospital Zurich, Switzerland
| | - Matko Marlais
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute for Child Health, University College London, UK
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Alaa Ali
- Great North Children's Hospital Newcastle, UK
| | - Abrar Alsharief
- Department of Pediatric Nephrology, The Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anja Blejc Novak
- Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marta Brambilla
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Evrim Kargin Cakici
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Cengiz Candan
- Instanbul Medeniyet University, Department of Pediatric Nephrology, Istanbul, Türkiye
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong
| | - Stéphane Decramer
- Paediatric Nephrology Centre, Hôpital des Enfants, CHU Purpan, Centre de Référence du Sud-Ouest des Maladies Rénales Rares SORARE, Filière ORKiD Toulouse, France
| | - Madeleine Didsbury
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
| | - Filipa Durao
- Pediatric Nephrology and Kidney Transplantation Unit, Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Anne M Durkan
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, Australia
| | - Ali Düzova
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Thomas Forbes
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Valentina Gracchi
- Department of pediatric nephrology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tulin Güngör
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Belde Kasap Demir
- İzmir Katip Çelebi University, Department of Pediatrics, Division of Pediatric Nephrology and Rheumatology, Türkiye
- Health Sciences University Tepecik Training and Research Hospital, Divisions of Pediatric Nephrology and Rheumatology, Türkiye
| | - Yasuko Kobayashi
- Gunma University Graduate School of Medicine, Department of Pediatric, Gunma, Japan
| | - Mikael Koskela
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eda Didem Kurt-Sukur
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Dean Langan
- UCL Great Ormond Street Institute for Child Health, University College London, UK
| | - Xiaozhong Li
- Pediatric Nephrologic and Immunologic Department, Children's hospital of Soochow University, China
| | - Gabriele Malgieri
- Division of Nephrology, Dialysis and Transplant, AORN Santobono Pausilipon, Napoli, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Jeesu Min
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | | | - Nabila Moussaoui
- Paediatric Nephrology Centre, Hôpital des Enfants, CHU Purpan, Centre de Référence du Sud-Ouest des Maladies Rénales Rares SORARE, Filière ORKiD Toulouse, France
| | - Aytul Noyan
- Baskent University, Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu)
| | | | - Takayuki Okamoto
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Louise Oni
- Department of Women's and Children's health, Alder Hey Children's NHS Foundation Trust Hospital and University of Liverpool, UK
| | - Michiel Oosterveld
- Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Gonul Parmaksiz
- Baskent University, Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Pornpimol Rianthavorn
- Department of Pediatrics, Faculty of Medecine, Chulalongkorn University, Bangkok, Thailand
| | - Joris Roelofs
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Yunyan Shen
- Pediatric Nephrologic and Immunologic Department, Children's hospital of Soochow University, China
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | | | - Tomohiro Udagawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Martin Wennerström
- Department of Pediatric Nephrology, The Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Yok Chin Yap
- Department of Paediatric, Hospital Tunku Azizah, Women and Children Hospital Kuala Lumpur, Malaysia
| | - Kjell Tullus
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children, London, UK
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4
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Abstract
BACKGROUND In children with hypernatremia, current clinical guidelines recommend a reduction in serum sodium of 0.5 mmol/L per hour or less to avoid complications of cerebral edema. However, no large-scale studies have been conducted in the pediatric setting to inform this recommendation. Therefore, this study aimed to report the association between the rate of correction of hypernatremia, neurological outcomes, and all-cause mortality in children. METHODS A retrospective cohort study was conducted from 2016 to 2019 at a quaternary pediatric center in Melbourne, Victoria, Australia. All children with at least one serum sodium level ≥150 mmol/L were identified through interrogation of the hospital's electronic medical record. Medical notes, neuroimaging reports, and electroencephalogram results were reviewed for evidence of seizures and/or cerebral edema. The peak serum sodium level was identified and correction rates over the first 24 hours and overall were calculated. Unadjusted and multivariable analyses were used to examine the association between the rate of sodium correction and neurological complications, the requirement for neurological investigation, and death. RESULTS There were 402 episodes of hypernatremia among 358 children over the 3-year study period. Of these, 179 were community-acquired and 223 developed during admission. A total of 28 patients (7%) died during admission. Mortality was higher in children with hospital-acquired hypernatremia, as was the frequency of intensive care unit admission and hospital length of stay. Rapid correction (>0.5 mmol/L per hour) occurred in 200 children and was not associated with greater neurological investigation or mortality. Length of stay was longer in children who received slow correction (<0.5 mmol/L per hour). CONCLUSIONS Our study did not find any evidence that rapid sodium correction was associated with greater neurological investigation, cerebral edema, seizures, or mortality; however, slow correction was associated with a longer hospital length of stay.
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Affiliation(s)
- Madeleine Didsbury
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Emily J. See
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
- School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl R. Cheng
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of General Medicine and EMR Team, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua Kausman
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Quinlan
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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5
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Kim S, Van Zwieten A, Lorenzo J, Khalid R, Lah S, Chen K, Didsbury M, Francis A, Mctaggart S, Walker A, Mackie FE, Prestidge C, Teixeira-Pinto A, Tong A, Blazek K, Barton B, Craig JC, Wong G. Cognitive and academic outcomes in children with chronic kidney disease. Pediatr Nephrol 2022; 37:2715-2724. [PMID: 35243536 PMCID: PMC9489550 DOI: 10.1007/s00467-022-05499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few data exist on the cognitive and academic functioning of children with chronic kidney disease (CKD) over the trajectory of their illness. We aimed to determine the association between CKD stages and cognitive and academic performance in children over time. METHODS We included 53 participants (aged 6-18 years) with CKD stages 1-5 (n = 37), on dialysis (n = 3), or with functioning kidney transplant (n = 22) from three units in Australia from 2015 to 2019. Participants undertook a series of psychometric tests and were invited for repeated assessments annually. We used linear regression and linear mixed models to investigate the effect of CKD stage, adjusted for socioeconomic status. RESULTS At baseline, full-scale intelligence quotient (FSIQ) (95%CI) of children on kidney replacement therapy (KRT) was in the low average range (87: 78, 96) and average (101: 95, 108) for children with CKD 1-5. Mean (95%CI) FSIQ, word reading, numerical operations, and spelling scores for children on KRT were 14.3 (- 25.3, - 3.3), 11 (- 18.5, - 3.6), 8.5 (- 17.6, 0.76), and 10 (- 18.6, - 1.3) points lower than children with CKD Stages 1-5. Spelling and numerical operations scores declined by 0.7 (- 1.4, - 0.1) and 1.0 (- 2.0, 0.2) units per year increase in age, regardless of CKD stage. CONCLUSIONS Children treated with KRT have low average cognitive abilities and lower academic performance for numeracy and literacy compared to both children with CKD 1-5 and to the general population. However, the rate of decline in academic performance over time is similar for children across the full spectrum of CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia. .,Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Anita Van Zwieten
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jennifer Lorenzo
- grid.413973.b0000 0000 9690 854XKids Neuroscience Centre, The Children’s Hospital at Westmead, Sydney, Australia
| | - Rabia Khalid
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Suncica Lah
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, Australia
| | - Kerry Chen
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Madeleine Didsbury
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anna Francis
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia ,grid.240562.7Child & Adolescent Renal Service, Queensland Children’s Hospital, Brisbane, Australia
| | - Steven Mctaggart
- grid.240562.7Child & Adolescent Renal Service, Queensland Children’s Hospital, Brisbane, Australia
| | - Amanda Walker
- grid.416107.50000 0004 0614 0346Department of Renal Medicine, The Royal Children’s Hospital, Melbourne, Australia
| | - Fiona E. Mackie
- grid.414009.80000 0001 1282 788XDepartment of Nephrology, Sydney Children’s Hospital at Randwick, Sydney, Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Child Health, University of New South Wales, Sydney, Australia
| | - Chanel Prestidge
- grid.414054.00000 0000 9567 6206Department of Nephrology, Starship Children’s Hospital, Auckland, New Zealand
| | - Armando Teixeira-Pinto
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katrina Blazek
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Belinda Barton
- grid.413973.b0000 0000 9690 854XChildren’s Hospital Education Research Institute, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jonathan C. Craig
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Germaine Wong
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia ,grid.413252.30000 0001 0180 6477Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
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7
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Khalid R, Van Zwieten A, Kim S, Didsbury M, Francis A, Mctaggart S, Walker A, Mackie FE, Prestidge C, Teixeira-Pinto A, Barton B, Lorenzo J, Lah S, Howard K, Nassar N, Au E, Tong A, Blazek K, Craig JC, Wong G. Association between socioeconomic status and academic performance in children and adolescents with chronic kidney disease. Pediatr Nephrol 2022; 37:3195-3204. [PMID: 35355084 PMCID: PMC9587100 DOI: 10.1007/s00467-022-05515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lower socioeconomic status (SES) is associated with lower academic achievement; however, this relationship is understudied in children with chronic kidney disease (CKD). This study examined the relationship between SES and academic performance in children and adolescents with CKD. METHODS A total of 377 participants aged 6-18 years with CKD stages 1-5 (n = 199), on dialysis (n = 43) or with a kidney transplant (n = 135) were recruited. Five SES measures and a composite SES index were examined for associations with parent-rated average or above average academic performance in numeracy and literacy using multivariable logistic regression. RESULTS Participants' median age was 12.6 years (IQR 8.9-15.5). Adjusted odds ratios (aOR) (95%CI) for better performance in numeracy and literacy, respectively, were 0.71 (0.44-1.15) and 0.75 (0.45-1.23) for children whose caregivers had lower educational attainment; 0.46 (0.26-0.80) and 0.53 (0.30-0.93) for lower household income; 0.52 (0.32-0.85) and 0.44 (0.26-0.73) for caregivers who were unemployed; 0.68 (0.41-1.12) and 0.59 (0.35-1.00) for caregivers with poor self-rated financial status; and 0.93 (0.53-1.64) and 1.00 (0.56-1.79) for caregivers who did not own their own home. Compared with the highest SES index quartile, the aORs for better performance by SES quartile in descending order were 1.24 (0.60-2.54), 0.76 (0.37-1.58), and 0.39 (0.18-0.86) for numeracy and 0.88 (0.41-1.85), 0.77 (0.35-1.66), and 0.32 (0.14-0.72) for literacy. No interactions were identified between SES and CKD stage, child age, or gender. CONCLUSIONS Across all CKD stages, children from lower SES families are less likely to perform well in literacy and numeracy than those from higher SES households. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rabia Khalid
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Anita Van Zwieten
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Madeleine Didsbury
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anna Francis
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Child & Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Steven Mctaggart
- Child & Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Amanda Walker
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Australia
| | - Fiona E Mackie
- Department of Nephrology, Sydney Children's Hospital at Randwick, Sydney, Australia
| | - Chanel Prestidge
- Department of Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Sydney, Australia
| | - Jennifer Lorenzo
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Eric Au
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katrina Blazek
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
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8
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Didsbury M, van Zwieten A, Chen K, James LJ, Francis A, Kim S, McTaggart S, Walker A, Mackie F, Kara T, Prestidge C, Teixeira-Pinto A, Barton B, Lorenzo J, Lah S, Howard K, Nassar N, Au E, Tong A, Craig JC, Wong G. The association between socioeconomic disadvantage and parent-rated health in children and adolescents with chronic kidney disease-the Kids with CKD (KCAD) study. Pediatr Nephrol 2019; 34:1237-1245. [PMID: 30788589 DOI: 10.1007/s00467-019-04209-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the association of socioeconomic disadvantage and parent-rated health in children with chronic kidney disease (CKD). METHODS A total of 377 children (aged 6-18 years) with CKD stages I-V (n = 199), on dialysis (n = 43), or with a kidney transplant (n = 135) were recruited from 2012 to 2016 in Australia and New Zealand. Associations of five socioeconomic status (SES) components and the global SES index with parent-rated health of the child were examined using adjusted logistic regression. RESULTS The median age of participants was 12.6 years (interquartile range (IQR) 8.9-15.5). In the entire cohort, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for poor parent-rated health were 1.85 (1.13-3.03) for lower household income, 1.78 (1.08-2.96) for families that did not own their own home, 2.50 (1.50-4.16) for caregivers who rated their financial status as poor, 0.84 (0.51-1.38) for lower educational attainment, and 1.68 (1.04-2.72) for children whose primary caregivers were unemployed. With reference to the highest global SES index quartile, adjusted ORs for poor parent-rated health in descending order were 1.49 (0.69-3.21), 2.11 (1.06-4.20), and 2.20 (1.09-4.46), respectively. The association between low SES and poor parent-rated health was modified by CKD stage, where lower global SES index was independently associated with poor parent-rated health in children with CKD stages I-V, but not children on dialysis or with kidney transplants (p = 0.04). CONCLUSIONS Low SES is associated with poor parent-rated health in children with CKD stages I-V, but not children on dialysis and with kidney transplants.
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Affiliation(s)
- Madeleine Didsbury
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Anita van Zwieten
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Kerry Chen
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Laura J James
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Anna Francis
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Child & Adolescent Renal Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Steven McTaggart
- Child & Adolescent Renal Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Amanda Walker
- Department of Renal Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Fiona Mackie
- Department of Nephrology, Sydney Children's Hospital at Randwick, Sydney, Australia
| | - Tonya Kara
- Department of Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Chanel Prestidge
- Department of Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Sydney, Australia
| | - Jennifer Lorenzo
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, Australia.,The ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Eric Au
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia. .,Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
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9
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Francis A, Didsbury M, McCarthy H, Kara T. Treatment of recurrent focal segmental glomerulosclerosis post-kidney transplantation in Australian and New Zealand children: A retrospective cohort study. Pediatr Transplant 2018; 22:e13185. [PMID: 29676031 DOI: 10.1111/petr.13185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/27/2022]
Abstract
Disease recurrence affects around a third of renal transplants for children with FSGS and is associated with poor graft outcomes. Unfortunately, there are no large trials guiding treatment for recurrent FSGS. We aimed to describe current therapies and treatment response for recurrent FSGS in 4 centres in Australia and New Zealand. Data were collected on children (age <18 years) with recurrent FSGS (1990-2015). We reviewed patient charts to obtain clinical information. Ethics approval was obtained from the relevant boards. Complete records were available on 24 patients (62% female, 54% Caucasian). Median time to first recurrence was 4 days (IQR 2-5 days). There were 14 separate treatment regimens, involving an average of 2 agents. The most common therapies were plasma exchange (20/24 patients, 83%), cyclosporin (15/24, 63%), and methylprednisolone (9/24, 38%). Full remission was achieved in 15 (63%), partial remission in 2 (8%), and no remission in 7 (29%) patients. Of the patients with no remission, 5 lost their graft to recurrent disease and 1 to concurrent acute vascular rejection. The plethora of different treatment regimens reflects the poor evidence guiding management for recurrent FSGS. More research is needed to improve outcomes.
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Affiliation(s)
- Anna Francis
- Child and Adolescent Renal Services, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia.,Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia
| | - Madeleine Didsbury
- Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia.,Paediatric Nephrology, Sydney Children's Hospitals Network, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Tonya Kara
- Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia.,Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand
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10
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Chen K, Didsbury M, van Zwieten A, Howell M, Kim S, Tong A, Howard K, Nassar N, Barton B, Lah S, Lorenzo J, Strippoli G, Palmer S, Teixeira-Pinto A, Mackie F, McTaggart S, Walker A, Kara T, Craig JC, Wong G. Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2018; 13:387-397. [PMID: 29472306 PMCID: PMC5967677 DOI: 10.2215/cjn.09650917] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Poor cognition can affect educational attainment, but the extent of neurocognitive impairment in children with CKD is not well understood. This systematic review assessed global and domain-specific cognition and academic skills in children with CKD and whether these outcomes varied with CKD stage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Electronic databases were searched for observational studies of children with CKD ages 21 years old or younger that assessed neurocognitive or educational outcomes. Risk of bias was assessed using a modified Newcastle-Ottawa scale. We used random effects models and expressed the estimates as mean differences with 95% confidence intervals stratified by CKD stage. RESULTS Thirty-four studies (25 cross-sectional, n=2095; nine cohort, n=991) were included. The overall risk of bias was high because of selection and measurement biases. The global cognition (full-scale intelligence quotient) of children with CKD was classified as low average. Compared with the general population, the mean differences (95% confidence intervals) in full-scale intelligence quotient were -10.5 (95% confidence interval, -13.2 to -7.72; all CKD stages, n=758), -9.39 (95% confidence interval, -12.6 to -6.18; mild to moderate stage CKD, n=582), -16.2 (95% confidence interval, -33.2 to 0.86; dialysis, n=23), and -11.2 (95% confidence interval, -17.8 to -4.50; transplant, n=153). Direct comparisons showed that children with mild to moderate stage CKD and kidney transplants scored 11.2 (95% confidence interval, 2.98 to 19.4) and 10.1 (95% confidence interval, -1.81 to 22.0) full-scale intelligence quotient points higher than children on dialysis. Children with CKD also had lower scores than the general population in executive function and memory (verbal and visual) domains. Compared with children without CKD, the mean differences in academic skills (n=518) ranged from -15.7 to -1.22 for mathematics, from -9.04 to -0.17 for reading, and from -14.2 to 2.53 for spelling. CONCLUSIONS Children with CKD may have low-average cognition compared with the general population, with mild deficits observed across academic skills, executive function, and visual and verbal memory. Limited evidence suggests that children on dialysis may be at greatest risk compared with children with mild to moderate stage CKD and transplant recipients.
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Affiliation(s)
- Kerry Chen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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11
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Francis A, Didsbury M, Lim WH, Kim S, White S, Craig JC, Wong G. The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children. Pediatr Nephrol 2016; 31:1011-9. [PMID: 26692022 DOI: 10.1007/s00467-015-3279-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low socioeconomic status (SES) and geographic disparity have been associated with worse outcomes and poorer access to pre-emptive transplantation in the adult end-stage kidney disease (ESKD) population, but little is known about their impact in children with ESKD. The aim of our study was to determine whether access to pre-emptive transplantation and transplant outcomes differ according to SES and geographic remoteness in Australia. METHODS Using data from the Australia and New Zealand Dialysis and Transplant Registry (1993-2012), we compared access to pre-emptive transplantation, the risk of acute rejection and graft failure, based on SES and geographic remoteness among Australian children with ESKD (≤ 18 years), using adjusted logistic and Cox proportional hazard modelling. RESULTS Of the 768 children who commenced renal replacement therapy, 389 (50.5%) received living donor kidney transplants and 28.5% of these (111/389) were pre-emptive. There was no significant association between SES quintiles and access to pre-emptive transplantation, acute rejection or allograft failure. Children residing in regional or remote areas were 35% less likely to receive a pre-emptive transplant compared to those living in major cities [adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.45-1.0]. There was no significant association between geographic disparity and acute rejection (adjusted OR 1.03, 95% CI 0.68-1.57) or graft loss (adjusted hazard ratio 1.05, 95% CI 0.74-1.41). CONCLUSIONS In Australia, children from regional or remote regions are much less likely to receive pre-emptive kidney transplantation. Strategies such as improved access to nephrology services through expanding the scope of outreach clinics, and support for regional paediatricians to promote early referral may ameliorate this inequity.
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Affiliation(s)
- Anna Francis
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Madeleine Didsbury
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Wai H Lim
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Siah Kim
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Sarah White
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006.
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Wong G, Medway M, Didsbury M, Tong A, Turner R, Mackie F, McTaggart S, Walker A, White S, Howard K, Kim S, Craig JC. Health and wealth in children and adolescents with chronic kidney disease (K-CAD study). BMC Public Health 2014; 14:307. [PMID: 24708535 PMCID: PMC4233636 DOI: 10.1186/1471-2458-14-307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 11/30/2022] Open
Abstract
Background The impact of reduced kidney function in children is substantial. End-stage kidney disease (ESKD), the most severe form of chronic kidney disease (CKD), is a devastating illness associated with substantially increased mortality, impaired growth and psychosocial maladjustment in children. Understanding how to address the complex causes of mortality and morbidity in children with CKD requires explicit information about the risk factors that lead to adverse outcomes. In addition to biological influences, the socioeconomic circumstances of caregivers may play a significant role in the health and well-being of children with CKD. Methods/Design A prospective cohort study (n = 380 children and n = 380 caregivers) will be conducted to determine the prevalence of economic hardship among caregivers of children with CKD. All participants will be followed biennially over a period of 5 years to determine the association between the changing socioeconomic status of the caregivers and the health and overall well-being of school-aged children with CKD. Face to face, semi-structured interviews with the caregivers (n = 45) will also be conducted to understand their perspectives on the economic, financial and psychosocial impact of CKD and how this affects the health outcomes of their child with CKD. The primary outcomes of the study are the effects of the socioeconomic status of the caregivers and self-reported health status of the children. Secondary outcomes included the prevalence of economic hardship and the distribution of wealth among the caregivers of children with CKD. Discussion Findings from this study presents not only a snapshot of the current economic and social situation of the caregivers of children and adolescents with CKD but will also provide definitive evidence of determining whether a link between socioeconomic status of caregivers and outcomes of children with CKD exists.
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Affiliation(s)
- Germaine Wong
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, Australia.
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