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

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

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Fig. 1

Abbreviations

BP:

Blood pressure

BMI:

Body mass index

CNS:

Central nervous system

CKD:

Chronic kidney disease

CKiD:

Chronic Kidney Disease in Children

CAKUT:

Congenital anomalies of the kidney and the urinary tract

DBP:

Diastolic blood pressure

eGFRs:

Estimated glomerular filtration rates

HTN:

Hypertension

K-CBCL:

Korean-Child Behavioral Checklist

KNOW-Ped CKD:

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

KRW:

Korean Won

SBP:

Systolic blood pressure

UPCR:

Urine protein to creatinine ratio

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Funding

KNOW-Ped CKD (trial registration: NCT02165878-ClinicalTrials.gov) 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.

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Correspondence to Kyoung Hee Han.

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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.

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Kang, N.R., Ahn, Y.H., Park, E. et al. Mental health and psychosocial adjustment in pediatric chronic kidney disease derived from the KNOW-Ped CKD study. Pediatr Nephrol 34, 1753–1764 (2019). https://doi.org/10.1007/s00467-019-04292-w

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Keywords

  • Mental health
  • Psychosocial adjustment
  • Chronic kidney disease
  • Children