Challenging prevailing wisdom that only children with end-stage kidney disease suffer physical, social, emotional and educational setbacks from their disease, research led by Johns Hopkins Children’s Center shows that even mild to moderate kidney disease may seriously diminish a child’s quality of life.
The findings, reported in the February issue of Pediatrics, suggest that earlier attention to quality-of-life issues in children with chronic kidney disease is needed.
“Even mild and moderate declines in kidney function may lead to serious physical, emotional, intellectual and social challenges,” says lead investigator Arlene Gerson, Ph.D., a paediatric psychologist at Hopkins Children’s. “What this means is we should be thinking about screening children for these challenges and intervening earlier than we once thought.”
For example, recently diagnosed children who report learning problems may benefit from help before grades drop, researchers say.
In their study of 402 children, ages 2 to 16, with mild-to-moderate kidney disease, researchers analysed the link between kidney function, disease severity, age of onset and disease duration on the one hand, and physical, emotional, psychological and school functioning on the other.
The researchers also compared quality of life outcomes between healthy children and children with early-stage kidney disease. Children with mild-to-moderate kidney disease and their parents reported worse overall outcomes on standard quality of life questionnaires and worse outcomes on all quality of life factors.
Specifically, children with early-stage kidney disease scored on average 75 out of 100 on quality of life measures, compared to 83 out of 100 for healthy children. The difference was especially pronounced in school functioning, where children with early-stage kidney disease scored 64 out 100, compared to 80 out of 100 for healthy children.
The study also found that the younger the child at the time of the diagnosis and the longer the child lived with kidney disease, the better the overall quality of life, a surprising finding suggesting that as time passes children learn to cope better with their condition, the researchers say.
The researchers found that children with impaired growth and shorter stature, a common effect of their disease, had worse overall quality of life and poorer physical functioning, an indicator of the importance of early treatment.
“Timely and individually tailored treatment, be it with nutrition, salt supplements or growth hormones, if needed, can make a big difference. We cannot overemphasise the importance of early intervention in children with early stages of chronic kidney disease,” says senior investigator Susan Furth, M.D. Ph.D., a paediatric nephrologist at Hopkins Children’s.
The research is part of an ongoing 57 centre study funded by the National Institutes of Health to study chronic kidney disease in children.
This article is courtesy of the Johns Hopkins Children Centre USA.
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