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Health-related quality of life in children with chronic kidney disease is affected by the number of medications

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Abstract

Introduction

The number of medications could serve as a surrogate for burden of care at home and may affect health-related quality of life (HRQoL) in children with chronic kidney disease (CKD).

Methods

Using baseline data from the Chronic Kidney Disease in Children (CKiD) Study, we modeled HRQoL scores, self-reported by the child (if ≥ 8 years old) and/or caregiver (all children) on unique counts and administrations of CKD- and non-CKD-related medications, using multivariate linear regression. Heterogeneity of associations between HRQoL and medication burden by age group (≥ 8 vs. < 8 years old) were explored.

Results

734 participants median age 11 years, disease duration 8 years, median eGFR 53 mL/min/1.73 m2, 61% male, 22% African-American, 31% glomerular disease were prescribed median 3 unique CKD-related medications. Regarding HRQoL assessment, 201 children were < 8 years old and had only parent-proxy HRQoL score; 533 children ≥ 8 years of age had both child and parent-proxy scores. Overall, parents of children < 8 years old reported higher HRQoL scores than parents of older children: 84 vs. 76. However, in a unified multivariate regression model, HRQoL scores of children < 8 years showed greater decreases as the number of CKD-related medications increased compared to scores for children ≥ 8 years old.

Conclusion

Average HRQoL scores reported by parents of younger CKD children were higher than those of older CKD children but decreased more with increased CKD medication counts than scores of older children. Considerations of HRQoL may be of particular importance for clinicians and caregivers when managing chronic disease comorbidities in younger children.

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Abbreviations

CKD:

Chronic kidney disease

KF:

Kidney failure

HRQoL:

Health-related quality of life

eGFR:

Estimated Glomerular Filtration Rate

CKiD:

Chronic Kidney Disease in Children Study

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Acknowledgments

The authors would like to thank the patients, parents, and collaborators of the CKiD study. We also would like to thank Ms. Kelly Townsend and Dr. Thomas Blydt-Hansen for their thoughts in the initial aspects of the study. 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. 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.

Funding

CKiD is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01DK-082194, U01-DK-66116). Dr. Ferris’ time was supported in part by the Renal Research Institute.

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Authors and Affiliations

  1. The University of North Carolina at Chapel Hill School of Medicine, 231 MacNider Hall, CB# 7225, Chapel Hill, NC, 27599-7225, USA

    Maria E. Díaz-González de Ferris & Stephen R. Hooper

  2. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Chris B. Pierce

  3. Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    Debbie S. Gipson

  4. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan L. Furth

  5. Children’s Mercy Kansas City and the University of Missouri—Kansas City School of Medicine, Kansas City, KS, USA

    Bradley A. Warady

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  1. Maria E. Díaz-González de Ferris
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  2. Chris B. Pierce
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  6. Stephen R. Hooper
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Authoring group for the CKiD Study

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Correspondence to Maria E. Díaz-González de Ferris.

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Díaz-González de Ferris, M.E., Pierce, C.B., Gipson, D.S. et al. Health-related quality of life in children with chronic kidney disease is affected by the number of medications. Pediatr Nephrol 36, 1307–1310 (2021). https://doi.org/10.1007/s00467-021-04919-x

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  • DOI: https://doi.org/10.1007/s00467-021-04919-x

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