Mental health and psychosocial adjustment in pediatric chronic kidney disease derived from the KNOW-Ped CKD study

  • Na Ri Kang
  • Yo Han Ahn
  • Eujin Park
  • Hyun Jin Choi
  • Seong Heon Kim
  • Heeyeon Cho
  • Min Hyun Cho
  • Jae Il Shin
  • Joo Hoon Lee
  • Young Seo Park
  • Hae Il Cheong
  • Hee Gyung Kang
  • Il-Soo Ha
  • Young Sook Kwack
  • Kyoung Hee HanEmail author
Original Article
Part of the following topical collections:
  1. What’s New in Chronic Kidney Disease



Psychosocial development of pediatric chronic kidney disease (CKD) patients is substantially affected due to growth retardation, frequent school absences, and difficulties engaging in normal peer relationship activities. While many studies focus on specific issues such as depression, anxiety, or neurocognitive function, few evaluate prevalence of various types of mental health and psychosocial adjustment problems among children with CKD. This study aimed to investigate these within the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD).


One hundred sixty-six subjects who completed the Korean-Child Behavioral Checklist (K-CBCL) were included. The clinical group comprised subjects with scores indicating psychosocial adjustment or mental health problems using the T scores for the 14 subscales of the K-CBCL. We analyzed associations between mental health or adjustment problems in pediatric CKD and each variable.


Mean age was 11.1 (± 3.9) years, number of males was 117 (70.5%), and 20.5% and 22.3% of children had significant mental health problems and psychosocial adjustment problems, respectively. Overall, 33.1% were assigned to the clinical group, and exhibited short stature and higher rates of preterm birth history compared to the non-clinical group. Subjects with adjustment problems had higher comorbidities such as CNS disease, developmental delay, cardiovascular disease, and multi-organ involvement. Logistic regression analysis revealed preterm birth and developmental delay correlated highly with clinical group.


A significant proportion of children and adolescents with CKD experience mental health and adjustment problems. In particular, patients with developmental delay or preterm birth history require screening and targeted follow-up.


Mental health Psychosocial adjustment Chronic kidney disease Children 



Blood pressure


Body mass index


Central nervous system


Chronic kidney disease


Chronic Kidney Disease in Children


Congenital anomalies of the kidney and the urinary tract


Diastolic blood pressure


Estimated glomerular filtration rates




Korean-Child Behavioral Checklist


KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease


Korean Won


Systolic blood pressure


Urine protein to creatinine ratio



KNOW-Ped CKD (trial registration: was funded by grants 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, and 2013E3301602, which were awarded by the Research of Korea Centers for Disease Control and Prevention following peer review.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review boards of the participating centers in South Korea; namely, Jeju National University Hospital (Jeju), Pusan National University Children’s Hospital (Yangsan), Severance Children’s Hospital (Seoul), Kyungpook National University Children’s Hospital (Daegu), Seoul National University Children’s Hospital (Seoul), Samsung Medical Center (Seoul), and Asan Medical Center Children’s Hospital (Seoul). Children with CKD aged < 18 years were enrolled in this study after informed consent had been obtained from their parents or guardians.

Supplementary material

467_2019_4292_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21 kb)


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Copyright information

© IPNA 2019

Authors and Affiliations

  • Na Ri Kang
    • 1
  • Yo Han Ahn
    • 2
  • Eujin Park
    • 3
  • Hyun Jin Choi
    • 4
  • Seong Heon Kim
    • 5
  • Heeyeon Cho
    • 6
  • Min Hyun Cho
    • 7
  • Jae Il Shin
    • 8
  • Joo Hoon Lee
    • 9
  • Young Seo Park
    • 9
  • Hae Il Cheong
    • 4
    • 10
  • Hee Gyung Kang
    • 4
    • 10
  • Il-Soo Ha
    • 4
    • 10
  • Young Sook Kwack
    • 1
  • Kyoung Hee Han
    • 1
    Email author
  1. 1.Department of PsychiatryJeju National University School of MedicineJejuRepublic of Korea
  2. 2.Department of PediatricsSeoul National University Bundang HospitalSeongnamRepublic of Korea
  3. 3.Department of PediatricsHallym University Kangnam Sacred Heart HospitalSeoulRepublic of Korea
  4. 4.Department of PediatricsSeoul National University Children’s HospitalSeoulRepublic of Korea
  5. 5.Department of PediatricsPusan National University Children’s HospitalYangsanRepublic of Korea
  6. 6.Department of Pediatrics, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  7. 7.Department of PediatricsKyungpook National University, School of MedicineDaeguRepublic of Korea
  8. 8.Department of PediatricsYonsei University College of Medicine, Severance Children’s HospitalSeoulRepublic of Korea
  9. 9.Department of Pediatrics, Asan Medical Center Children’s HospitalUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  10. 10.Department of PediatricsSeoul National University College of MedicineSeoulRepublic of Korea

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