Patient-Reported Outcomes Over 24 Months in Pediatric CKD: Findings From the MyKidneyHealth Cohort Study

Sandra Amaral, Julia Schuchard, Donna Claes, Allison Dart, Larry A. Greenbaum, Susan F. Massengill, Meredith A. Atkinson, Joseph T. Flynn, Vikas R. Dharnidharka, Sahar Fathallah-Shaykh, Ora Yadin, Zubin J. Modi, Amira Al-Uzri, Amy C. Wilson, Katherine M. Dell, Hiren P. Patel, Cortney Bruno, Bradley Warady, Susan Furth, Christopher B. Forrest

Research output: Contribution to journalArticlepeer-review

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Abstract

Rationale & Objective: The lived experience of children with chronic kidney disease (CKD) is poorly characterized. We examined the associations between patient-reported outcome (PRO) scores measuring their fatigue, sleep health, psychological distress, family relationships, and global health with clinical outcomes over time in children, adolescents, and younger adults with CKD and investigated how the PRO scores of this group compare with those of other children, adolescents, and younger adults. Study Design: Prospective cohort study. Setting & Participants: 212 children, adolescentss, and adults aged 8 to 21 years with CKD and their parents recruited from 16 nephrology programs across North America. Predictors: CKD stage, disease etiology, and sociodemographic and clinical variables. Outcome: PRO scores over 2 years. Analytical Approach: We compared PRO scores in the CKD sample with a nationally representative general pediatric population (ages 8 to 17 years). Change of PROs over time and association of sociodemographic and clinical variables with PROs were assessed using multivariable regression models. Results: For all time points, 84% of the parents and 77% of the children, adolescents, and younger adults completed PRO surveys. The baseline PRO scores for the participants with CKD revealed a higher burden of fatigue, sleep-related impairment, psychological distress, impaired global health, and poorer family relationships compared with the general pediatric population, with median score differences ≥1 SD for fatigue and global health. The baseline PRO scores did not differ by CKD stage or glomerular versus nonglomerular etiology. Over 2 years, PROs were stable with a <1-point annual change on average on each measure and intraclass correlation coefficients ranging from 0.53 to 0.79, indicating high stability. Hospitalization and parent-reported sleep problems were associated with worse fatigue, psychological health, and global health scores (all P < 0.04). Limitations: We were unable to assess responsiveness to change with dialysis or transplant. Conclusions: Children with CKD experience a high yet stable burden of impairment across numerous PRO measures, especially fatigue and global health, independent of disease severity. These findings underscore the importance of assessing PROs, including fatigue and sleep measures, in this vulnerable population. Plain-Language Summary: Children with chronic kidney disease (CKD) have many treatment demands and experience many systemic effects. How CKD impacts the daily life of a child is poorly understood. We surveyed 212 children, adolescents, and younger adults with CKD and their parents over 24 months to assess the participants’ well-being over time. Among children, adolescents, and younger adults with CKD we found a very high and persistent burden of psychological distress that did not differ by degree of CKD or type of kidney disease. The participants with CKD endorsed greater impairment in fatigue and global health compared with healthy children, adolescents, and younger adults, and parent-reported sleep problems were associated with poorer patient-reported outcome (PRO) scores across all domains. These findings emphasize the importance of including PRO measures, including fatigue and sleep measures, into routine clinical care to optimize the lived experience of children with CKD.

Original languageEnglish
Pages (from-to)213-224.e1
JournalAmerican Journal of Kidney Diseases
Volume82
Issue number2
DOIs
StatePublished - Aug 2023

Keywords

  • Chronic kidney disease
  • fatigue
  • patient-reported outcomes
  • pediatric
  • sleep

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