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A longitudinal analysis of the effect of anemia on health-related quality of life in children with mild-to-moderate chronic kidney disease

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Abstract

Background

To evaluate impact of anemia on health-related quality of life (HRQOL) over time in a large pediatric cohort with mild-to-moderate chronic kidney disease (CKD).

Methods

Participants were enrolled in the Chronic Kidney Disease in Children Study (CKiD), a multicenter, longitudinal cohort. HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL). Anemia was defined as hemoglobin < 5th percentile for age, sex, and race. Two longitudinal analyses were conducted on consecutive visit pairs. Models examined effects of anemia status on both HRQOL score over time and change in HRQOL score between consecutive visits. The sample included 733 children with a median estimated GFR 54 ml/min/1.73 m2. Thirty percent of children had anemia at index visit.

Results

Analysis of HRQOL scores revealed the presence of anemia was associated with significantly lower overall HRQOL (β = − 2.90 (95% CI = − 7.74, − 0.21), p = 0.04) and physical functioning (β = − 5.72 (− 9.49, − 2.25), p = 0.001) according to children. On parent ratings, the development of anemia was associated with lower emotional functioning scores (β = − 4.87 (− 8.72, − 0.11), p = 0.045). In the second model, children who developed anemia were rated by caregivers as having more decreased physical functioning than children who remained anemia-free (β = − 3.30 per year (− 5.83, − 0.76), p = 0.01). Caregivers did not observe declines in their children’s other PedsQL subscales in the presence of developed anemia. Children with resolved or persistence did not show improvement or decline in any aspect of HRQOL functioning relative to non-anemic subjects.

Conclusions

In children with CKD, anemia has an adverse effect on HRQOL which persists over time but does not appear to be progressive.

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Abbreviations

CKD:

chronic kidney disease

CKiD:

Chronic Kidney disease in Children Study

ESA:

erythropoietin stimulating agents

GFR:

glomerular filtration rate

HRQOL:

health-related quality of life

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Acknowledgments

Data in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri—Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health.

Funding

The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U24-DK-082194, U24-DK-66116). The CKiD website is located at https://statepi.jhsph.edu/ckid

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Joann Carlson

  2. Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Arlene C. Gerson

  3. Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Matthew B. Matheson

  4. Department of Medicine, Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Sharon Manne

  5. Division of Pediatric Nephrology, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

  6. Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Stephen R. Hooper

  7. Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA

    Marc Lande

  8. Division of Pediatric Nephrology, University of Iowa Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Lyndsay A. Harshman

  9. Division of Developmental and Behavioral Health, Department of Pediatrics, Children’s Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA

    Rebecca J. Johnson

  10. Department of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Shlomo Shinnar

  11. Children’s Hospital of Philadelphia, Division of Pediatric Nephrology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Amy J. Kogon & Susan Furth

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  1. Joann Carlson
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Correspondence to Joann Carlson.

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Carlson, J., Gerson, A.C., Matheson, M.B. et al. A longitudinal analysis of the effect of anemia on health-related quality of life in children with mild-to-moderate chronic kidney disease. Pediatr Nephrol 35, 1659–1667 (2020). https://doi.org/10.1007/s00467-020-04569-5

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