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.