The impact of CKD on disability and health-related quality of life (HRQoL) of children and adolescents

Abstract

Background: Children with CKD suffer from reduced HR-QOL. The extent of impairment and risk factors for poorer HR-QOL and disability are under-studied. The study aimed to compare overall HR-QOL and severity of disability in children and adolescents with different stages of CKD and to determine factors associated with lower HR-QOL scores. 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 utility based HR-QOL (where 0 represents being dead and 1 represents full health). A score of 1.00 represents no disability, 0.89-0.99 represents mild disability, 0.70-0.88 represents moderate disability and less than 0.70 represents severe disability. HR-QOL scores and disability stages 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 similar to kidney transplant recipients (0.83, IQR 0.59-0.97, p=0.4). Severe disability was more common in dialysis patients (20/35, 57%), compared to transplant recipients (37/114, 33%) or those with CKD stages 1-4 (57/176, 32%) (c2=8.4, p=0.02) (table 1). The 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) and lowest quartile family income (compared to highest income quartile: reduction by 0.10, 95%CI 0.01-0.20), when adjusted for age and gender. Conclusions: HR-QOL children with CKD was significantly related to stage of disease and family income, with children on dialysis and those the lowest family income having significant lower HR QOL. (Figure Presented).L6336979192020-12-23 <br />