Emotional, behavioural and adaptive function in children with chronic kidney disease: the Kids with CKD (KCAD) study

Abstract

BACKGROUND: Children living with chronic kidney disease (CKD) often experience significant psychological challenges, including emotional and behavioural difficulties linked to both the condition and its treatment. This study aimed to characterise the emotional, behavioural and adaptive functioning of children with CKD and to explore its relationship with CKD stage. METHODS: Participants aged 6-18 years with any stage of CKD were recruited, and the Behaviour Assessment System for Children (BASC-2) was used to assess emotional, behavioural and adaptive functioning. Multivariable logistic regression was used to assess the association of CKD stage with emotional and behavioural outcomes. RESULTS: The study included 53 participants, with a mean age of 12 years (s.d. 2.5). Among them, 27 (51%) were in CKD stages 1-5, 3 (6%) were receiving dialysis, and 22 (42%) had undergone kidney transplantation. In parent-report scales, an increased proportion of children with CKD were at risk for specific emotional difficulties (somatisation (n = 25, 47%), withdrawal (18, 33%), depression (17, 32%) and reduced adaptive skills (social skills and activities of daily living (17, 32%)) compared to general population norms. Children receiving kidney replacement therapy (KRT) were at an increased risk of adaptive skill deficits (OR 5.7, 95% CI 1.07-30.5) when compared to children with CKD stages 1-5, but there were uncertain differences between these groups for internalising (OR 1.1, 0.3-2.6) and externalising problems (OR 5.0, 0.85-29.5) and behavioural symptoms (OR 2.0, 0.4-9.4). CONCLUSIONS: Children with CKD are at increased risk of emotional difficulties (withdrawal, depression) and reduced social skills and activities of daily living compared to population norms. Adaptive skill deficits were more prevalent among children with KRT compared to children with CKD stages 1-5.