Abstract
Little research has been published assessing changes in the functional health status of children and adolescents with chronic kidney disease (CKD). We know little about which clinical parameters influence functional status or health-related quality of life in these young people. In a prospective study using data from semi-annual visits over a 4-year period from 78 adolescents with CKD aged 11 years to 18 years, we detail the impact of several clinical measures (i.e., kidney function, albumin, hematocrit, height) on short-term changes in health-related quality of life. The 50-item Child Health Questionnaire Parent Form, a validated health-related quality of life measure in children, was used to obtain physical and psychosocial functioning summary scores at each visit. After adjustment for the variables mentioned above, the physical summary score on the Child Health Questionnaire (CHQ) declined as glomerular filtration rate declined. Increasing height was associated with a positive change in physical and psychosocial summary scores. We conclude that decline in kidney function is associated with a subsequent decline in health-related quality of life, particularly in terms of physical activity.
Similar content being viewed by others
References
(1996) Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 7:198–207
Avram MM, Mittman N, Bonomini L, Chattopadhyay J, Fein P (1995) Markers for survival in dialysis: a seven-year prospective study. Am J Kidney Dis 26:209–219
Combe C, McCullough KP, Asano Y, Ginsberg N, Maroni BJ, Pifer TB (2004) Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): nutrition guidelines, indicators, and practices. Am J Kidney Dis 44:39–46
Don BR, Kaysen G (2004) Serum albumin: relationship to inflammation and nutrition. Semin Dial 17:432–437
Iseki K, Uehara H, Nishime K, Tokuyama K, Yoshihara K, Kinjo K, Shiohira Y, Fukiyama K (1996) Impact of the initial levels of laboratory variables on survival in chronic dialysis patients. Am J Kidney Dis 28:541–548
Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ (1998) Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 31:997–1006
Lowrie EG, Huang WH, Lew NL (1995) Death risk predictors among peritoneal dialysis and hemodialysis patients: a preliminary comparison. Am J Kidney Dis 26:220–228
Lowrie EG, Lew NL (1990) Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 15:458–482
Mann JF (1999) What are the short-term and long-term consequences of anaemia in CRF patients? Nephrol Dial Transplant 14 [Suppl 2]:29–36
Owen WF, Jr., Lew NL, Liu Y, Lowrie EG, Lazarus JM (1993) The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 329:1001–1006
Pifer TB, McCullough KP, Port FK, Goodkin DA, Maroni BJ, Held PJ, Young EW (2002) Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int 62:2238–2245
Strippoli GF, Craig JC, Manno C, Schena FP (2004) Hemoglobin targets for the anemia of chronic kidney disease: a meta-analysis of randomized, controlled trials. J Am Soc Nephrol 15:3154–3165
I. NKF-K/DOQI (2001) Clinical practice guidelines for hemodialysis adequacy: update 2000. Am J Kidney Dis 37:S7–S64
Eknoyan G, Levin N (2001) NKF-K/DOQI clinical practice guidelines: update 2000. Am J Kidney Dis 37:S5–S6 (foreword)
II. NKF-K/DOQI (2001) Clinical practice guidelines for peritoneal dialysis adequacy: update 2000. Am J Kidney Dis 37:S65–S136
III. NKF-K/DOQI (2001) Clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis 37:S137–S181
IV. NKF-K/DOQI (2001) Clinical practice guidelines for anemia of chronic kidney disease: update 2000. Am J Kidney Dis 37:S182–S238
Mitsnefes MM, Daniels SR, Schwartz SM, Meyer RA, Khoury P, Strife CF (2000) Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors. Pediatr Nephrol 14:898–902
Chavers B, Schnaper HW (2001) Risk factors for cardiovascular disease in children on maintenance dialysis. Adv Ren Replace Ther 8:180–190
Wong CS, Hingorani S, Gillen DL, Sherrard DJ, Watkins SL, Brandt JR, Ball A, Stehman-Breen CO (2002) Hypoalbuminemia and risk of death in pediatric patients with end-stage renal disease. Kidney Int 61:630–637
Warady BA, Ho M (2003) Morbidity and mortality in children with anemia at initiation of dialysis. Pediatr Nephrol 18:1055–1062
Uribarri J (2004) K/DOQI guidelines for bone metabolism and disease in chronic kidney disease patients: some therapeutic implications. Semin Dial 17:349–350
Cagney KA, Wu AW, Fink NE, Jenckes MW, Meyer KB, Bass EB, Powe NR (2000) Formal literature review of quality-of-life instruments used in end-stage renal disease. Am J Kidney Dis 36:327–336
Evans RW, Rader B, Manninen DL (1990) The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group. JAMA 263:825–830
Rocco MV, Gassman JJ, Wang SR, Kaplan RM (1997) Cross-sectional study of quality of life and symptoms in chronic renal disease patients: the Modification of Diet in Renal Disease Study. Am J Kidney Dis 29:888–896
Wu AW, Fink NE, Cagney KA, Bass EB, Rubin HR, Meyer KB, Sadler JH, Powe NR (2001) Developing a health-related quality-of-life measure for end-stage renal disease: The CHOICE Health Experience Questionnaire. Am J Kidney Dis 37:11–21
McMahon LP, Mason K, Skinner SL, Burge CM, Grigg LE, Becker GJ (2000) Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end-stage renal failure. Nephrol Dial Transplant 15:1425–1430
Gerson A, Hwang W, Fiorenza J, Barth K, Kaskel F, Weiss L, Zelikovsky N, Fivush B, Furth S (2004) Anemia and health-related quality of life in adolescents with chronic kidney disease. Am J Kidney Dis 44:1017–1023
Gerson AC, Riley A, Fivush BA, Pham N, Fiorenza J, Robertson J, Chandra M, Trachtman H, Weiss R, Furth SL (2005) Assessing health status and health care utilization in adolescents with chronic kidney disease. J Am Soc Nephrol 16:1427–1432
Landgraf JM, Abetz L, Ware JE (1996) The CHQ User’s Manual. The Health Institute, New England Medical Center, Boston, Mass, USA
Schwartz GJ, Haycock GB, Edelmann CM, Jr., Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263
Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130
Harrell FE Jr (2001) Regression modeling strategies. Springer, New York
Dempster AP, Laird NM, Rubin DB (1977) Maximum likelihood from incomplete data via the EM algorithm. J R Statist Soc B 39:1–38
Acknowledgments
This study was supported by grant no. K08 DK02586-01A1 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA and the Kidney and Urology Foundation of America. Drs. Furth and Gerson are currently supported by grant no. U01 DK66174 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland. Dr. Cole is supported, in part, by the National Institutes of Health through the data coordinating centers for the pediatric Chronic Kidney Disease cohort study (UO1-DK-066116), the Multicenter AIDS Cohort Study (UO1-AI-35043), and the Women’s Interagency HIV Study (UO1-AI-42590). Dr. Fadrowski is supported by the American Kidney Fund’s Clinical Scientist in Nephrology Fellowship Program.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fadrowski, J., Cole, S.R., Hwang, W. et al. Changes in physical and psychosocial functioning among adolescents with chronic kidney disease. Pediatr Nephrol 21, 394–399 (2006). https://doi.org/10.1007/s00467-005-2122-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-005-2122-3