THE IMPACT OF CHRONIC KIDNEY DISEASE (CKD) ON THE QUALITY OF LIFE OF CHILDREN AND ADOLESCENTS

A FRANCIS1,2,3, M DIDSBURY1,2, A VAN ZWIETEN1,2, K CHEN1,2, L JAMES1,2, S KIM1,2, K HOWARD, G WILLIAMS1,2, S MCTAGGART3, A WALKER4, F MACKIE5, T KARA6, N NASSAR2, A TEIXEIRA-PINTO1,2, A TONG1,2, DW JOHNSON7, JC CRAIG1,2, G WONG1,2,8

1Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales; 2Sydney School of Public Health, The University of Sydney, New South Wales; 3Child and Adolescent Renal Service, Children’s Health Queensland, Queensland; 4Department of Renal Medicine, The Royal Children’s Hospital, Melbourne, Victoria; 5Department of Nephrology, Sydney Children’s Hospital at Randwick, Sydney, New South Wales; 6Department of Nephrology, Starship Children’s Hospital, Auckland, New Zealand; 7Department of Nephrology, Princess Alexandra Hospital, Brisbane; 8Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales

Aim: To compare overall and domain-specific health-related quality of life (HR-QOL) of children and adolescents with different stages of CKD and to determine factors associated with lower HR-QOL scores.

Background: Children with CKD suffer from reduced quality of life. The extent of impairment and risk factors for poorer HR-QOL are under-studied.

Methods: HR-QOL data were collected from children and adolescents (age 6-18 years) across five paediatric units in Australia and New Zealand. The Health Utilities Index 3 survey was used to measure overall and sub-domain HR-QOL (range from -0.36 [worse than dead] to 1 [perfect health]). HR-QOL scores were compared between CKD stages using the Mann-Whitney-U test. Multivariable linear regression assessed factors associated with decline in HR-QOL.

Results: There were 377 children with CKD (median age 12.6 years). The median unadjusted HR-QOL score for those with CKD stages 1-4 was 0.88 (interquartile range [IQR] 0.61-0.97), higher than those on dialysis (0.67, IQR 0.39-0.91, p<0.001), but not different from those with kidney transplants (0.83, IQR 0.59-0.97, p=0.4). Compared to patients with earlier stage CKD, dialysis patients experienced significant decrements in median pain (0.23, p<0.001), emotion (0.09, p<0.001) and cognition (0.11, p=0.04) scores. On multivariable analysis, factors associated with decrements in HR-QOL were being on dialysis (compared to CKD stages 1-4: reduction by 0.13, 95%CI 0.02-0.24, p=0.02) and lowest quartile family income (compared to highest income quartile: reduction by 0.10, 95%CI 0.01-0.20, p=0.04), when adjusted for age (p=0.3) and gender (p=0.2).

Conclusions: The overall and specific domains of HR-QOL such as pain, emotion and cognition are substantially worse in children on dialysis compared to earlier stage CKD and those with kidney transplants.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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