Emotional and behavioural function of children with chronic kidney disease

Abstract

Background: Chronic kidney disease (CKD) is associated with neurodevelopmental changes and poorer long-term neurocognitive outcomes in children. Despite the importance of psychosocial development in childhood, few studies have comprehensively assessed emotional-behavioural functioning in children with CKD. Methods: We included 53 participants (aged 6-18 years) with CKD stages 1-5 (n=27), on dialysis (n=3) or with functioning kidney transplant (n=23) from three centres in Australia from 2015-2019. The Behaviour Assessment System for Children, 2nd edition (BASC-2) was used to assess children's psychosocial development in four areas: externalising problems (hyperactivity, aggression, and conduct problems), internalising problems (anxiety, depression, and somatisation), behavioural symptoms (atypicality, withdrawal, and attention problems) and adaptive skills (social skills, leadership, activities of daily living, functional adaptation, and adaptability). Results: Participants' median scores on the BASC-2 Parent Report Scale (PRS) fell within the normal range for all domains assessed, except for somatisation which fell in the “at risk” range. However, an increased proportion of children with CKDwere in the “at risk” range for depression (22%), somatisation (24%), internalising symptoms (20%), withdrawal (20%), attention difficulties (18%), social skills (24%), leadership (24%) and activities of daily living (26%). Additionally, there was an increased proportion of children in the “clinically significant” range for all domains except leadership and adaptive skills. Conclusions: Although children with CKD on average have behavioural scores within the normal range, there is a higher proportion of children who demonstrate, or are at risk for, psychosocial issues, particularly in the areas of adaptive skills and internalising problems.