Facilitators and Barriers to School Attendance in Children With CKD: A Cross-Sectional Survey

Abstract

Background: Children who experience chronic kidney disease (CKD) have poorer educational and vocational outcomes compared to their peers, with lower rates of school attendance identified as a major contributor. Aims: This study aims to quantify levels of school attendance in children with CKD and identify the facilitators and barriers to school participation. Methods: We conducted a cross-sectional survey of school attendance in children with CKD across three paediatric nephrology centres. Parents of children between 6 and 18 years of age with CKD 1-5 or on kidney replacement therapy (KRT) were invited by email and subsequently approached by the research team in clinic. Results: of the 103 people consented, 89 (86%) completed the survey. The average age of participants was 12 years, 63% (n = 56) were male and 47% (n = 42) had CKD stages 1-5, whilst 53% (n = 47) were on KRT. 39% (n = 35) were in primary school and 61% (n = 54) were in high school. In the last 4 weeks, only 8 children (9%) had full school attendance, with children with CKD missing an average of 4 full days (SD 6 days) and 2 half days (SD 4 half days) of school. Forty-three percent of parents (n = 38) reported CKD 'often' or 'almost always' reduced their child's ability to attend school. Facilitators to school attendance were Being with friends (91%, n = 81). Barriers to attendance included 'Illness' (70%, n = 62), Fatigue (31%, n = 28) and Pain (24%, n = 21). Discussion: Children with CKD often miss school and barriers to attendance include illness, fatigue, and pain. Future interventions should target these barriers and leverage facilitators to improve school attendance..