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Abildgaard Hansen O, Clemensen J, Beier CP, Barasinski Pedersen J, Smith AC, Kaas Larsen M. Living with epilepsy in adolescence and young adulthood transitioning from pediatric to adult hospital services: A systematic review and meta-synthesis of qualitative studies. Epilepsy Behav 2024; 158:109955. [PMID: 39059136 DOI: 10.1016/j.yebeh.2024.109955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Transition is characterized by developing greater self-identity and growing independence, but adolescents dealing with chronic illnesses encounter health-related and situational changes during transition. Despite the many suggestions made in recent years, the shift from pediatric to adult care continues to pose difficulties for adolescents and young adults with epilepsy (AWE). The holistic perspective of AWE's experiences and needs during transition is not as well understood. AIM To synthesize the qualitative evidence related to AWE's experiences and needs transitioning from pediatric to adult hospital care. METHODS This systematic review adhered to the rigorous Joanna Briggs methodology for qualitative evidence synthesis. A comprehensive search was conducted across multiple databases, including PubMed, CINAHL, Scopus, Embase, PsycINFO, and ProQuest Dissertations & Theses Global, from their inception to April 2024. The findings were critically appraised and aggregated using meta-synthesis. RESULTS The search yielded a total of 3,985 studies, and twenty-one were included in the review. Two of the included studies were undertaken in a program where a transition clinic was established. The meta-synthesis reveals that the transition experience of AWE is more than a change from one clinic to another and is interwoven into a pattern of developmental, health-illness, situational, and organizational transition issues. Five synthesized findings were developed: 1) Feeling different from others and striving to address the impact of epilepsy in everyday life; 2) the transition from pediatric to adult care - a problematic intersection point; 3) the family's role - support or parental overprotectiveness 4) seeking knowledge and being familiar with epilepsy supported by healthcare professionals and technologies, and 5) development of independence and responsibility through involvement and support from healthcare professionals and parents. CONCLUSION During the transition from pediatric to adult hospital care, AWEs encounter a loss of familiarity, increased responsibility, and feelings of not belonging. Therefore, it is essential to create an environment where they can thrive beyond the limitations of their illness. Understanding, acceptance, and inclusivity should characterize this environment to support AWEs in facilitating the development of responsibility, independence, and confidence as they navigate transitions.
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Affiliation(s)
- Ole Abildgaard Hansen
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4 5000, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9a 5000, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Kløvervænget 8C, Entrance 101 5000, Odense, Denmark.
| | - Jane Clemensen
- Centre for Innovative Medical Technology, University of Southern Denmark, Kløvervænget 8C, Entrance 101 5000, Odense, Denmark; Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Kløvervænget 23C 5000, Odense, Denmark.
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4 5000, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Kløvervænget 8C, Entrance 101 5000, Odense, Denmark.
| | - Jan Barasinski Pedersen
- Middelfart Municipality, Social and Health Administration, Nytorv 9 5500, Middelfart, Denmark.
| | - Anthony C Smith
- Centre for Innovative Medical Technology, University of Southern Denmark, Kløvervænget 8C, Entrance 101 5000, Odense, Denmark; Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, QLD 4102, Australia.
| | - Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, J.B. Winsløws Vej 4 5000, Odense, Denmark; Clinical Institute, University of Southern Denmark, Campusvej 55 5230, Odense, Denmark.
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Albatati S, Alnasser Y, Alomar O, Alsharidi T, Almousa H, Almezel S, Alabdulwahid A. Social determinants of health and quality of life in children with chronic kidney disease: insights from Saudi Arabia. BMC Nephrol 2024; 25:272. [PMID: 39182016 PMCID: PMC11344921 DOI: 10.1186/s12882-024-03710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Social determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia. METHODS This observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey. RESULTS The study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031). CONCLUSION Our study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL.
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Affiliation(s)
- Sawsan Albatati
- Section of Nephrology, Department of Pediatrics, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Yossef Alnasser
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Department, Bronxcare Health System, New York, NY, USA
- George Washington Milken School of Public Health, Washington, DC, USA
| | - Omar Alomar
- Section of Nephrology, Department of Pediatrics, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | | | - Hamad Almousa
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shahd Almezel
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Matsuda-Abedini M, Zappitelli M, Widger K, Rapoport A, Dionne JM, Chanchlani R, Samuel S, Davison SN, Bei KF, Wai Lai VK, Dufault B, Dart AB. Validation of Patient-Reported Outcome Measure in Pediatric CKD (PRO-Kid). Clin J Am Soc Nephrol 2024; 19:851-859. [PMID: 38861473 PMCID: PMC11254021 DOI: 10.2215/cjn.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
Key Points PRO-Kid is a patient-reported outcome measure of the frequency and burden of symptoms. Higher PRO-Kid scores are associated with lower Pediatric Quality of Life Inventory scores. Background Measuring the burden of symptoms that matter most to children and adolescents with CKD is essential for optimizing patient-centered care. We developed a novel CKD-specific patient-reported outcome measure (PRO-Kid) to assess both frequency and impact of symptoms in children. In this study, we further assessed the validity and internal consistency of PRO-Kid. Methods In this multicenter study, children age 8–18 years with stages 3–5 CKD, including those on dialysis, were recruited from five pediatric centers. Children completed the 14-item PRO-Kid questionnaire and the validated Pediatric Quality of Life Inventory (PedsQL 4.0). We explored the dimensionality of the PRO-kid scale using exploratory and confirmatory factor analysis, to either establish that it is a unidimensional construct or identify evidence of subfactors. We then assessed internal consistency (Cronbach alpha) and construct validity (Pearson correlations). Results In total, 100 children were included. The median eGFR was 27.4 ml/min per 1.73 m2 (7.43–63.4), and 26 children (26%) were on dialysis. Both the PRO-Kid frequency and the impact scales were unidimensional. Cronbach alpha was high for both the PRO-Kid frequency and impact scales, 0.83 (95% confidence interval [CI], 0.78 to 0.88) and 0.84 (95% CI, 0.80 to 0.89), respectively, showing strong internal consistency. Pearson correlations between PRO-Kid and PedsQL scores were also strong: −0.78 (95% CI, −0.85 to −0.70) for the frequency score and −0.69 (95% CI, −0.78 to −0.56) for the impact score, reflecting the association between poorer quality of life and higher symptom burden. Conclusions PRO-Kid is a novel patient-reported symptom burden tool for children age 8–18 years with CKD that correlates strongly in the expected direction with PedsQL, supporting its validity. Future work will evaluate changes in PRO-Kid score with progression of CKD and implementation of the tool into clinical care.
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Affiliation(s)
- Mina Matsuda-Abedini
- Division of Nephrology, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Paediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Zappitelli
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kimberley Widger
- Pediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Adam Rapoport
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Pediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada
- Emily House Children's Hospice, Toronto, Ontario, Canada
| | - Janis M Dionne
- Division of Nephrology, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Paediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Susan Samuel
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Sara N. Davison
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Ke Fan Bei
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Veronica Ka Wai Lai
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Allison B. Dart
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Carlson J, Gerson AC, Matheson MB, Manne S, Lande M, Harshman L, Johnson RJ, Shinnar S, Kogon AJ, Warady B, Furth S, Hooper S. Longitudinal changes of health-related quality of life in childhood chronic kidney disease. Pediatr Nephrol 2023; 38:4127-4136. [PMID: 37428223 PMCID: PMC10591962 DOI: 10.1007/s00467-023-06069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Few longitudinal studies have evaluated the impact of chronic kidney disease (CKD) duration on health-related quality of life (HRQOL). The study's aim was to determine how HRQOL changes over time in childhood CKD. METHODS Study participants were children in the chronic kidney disease in children (CKiD) cohort who completed the pediatric quality of life inventory (PedsQL) on three or more occasions over the course of two or more years. Generalized gamma (GG) mixed-effects models were applied to assess the effect of CKD duration on HRQOL while controlling for selected covariates. RESULTS A total of 692 children (median age = 11.2) with a median of 8.3 years duration of CKD were evaluated. All subjects had a GFR greater than 15 ml/min/1.73 m2. GG models with child self-report PedsQL data indicated that longer CKD duration was associated with improved total HRQOL and the 4 domains of HRQOL. GG models with parent-proxy PedsQL data indicated that longer duration was associated with better emotional but worse school HRQOL. Increasing trajectories of child self-report HRQOL were observed in the majority of subjects, while parents less frequently reported increasing trajectories of HRQOL. There was no significant relationship between total HRQOL and time-varying GFR. CONCLUSIONS Longer duration of the disease is associated with improved HRQOL on child self-report scales; however, parent-proxy results were less likely to demonstrate any significant change over time. This divergence could be due to greater optimism and accommodation of CKD in children. Clinicians can use these data to better understand the needs of pediatric CKD patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Joann Carlson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Arlene C Gerson
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sharon Manne
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Marc Lande
- University of Rochester Medical Center, Rochester, NY, USA
| | - Lyndsay Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Rebecca J Johnson
- Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA
| | - Shlomo Shinnar
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amy J Kogon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Warady
- Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA
| | - Susan Furth
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Hooper
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Impact of Hospitalization on the Quality of Life of Patients with Chronic Kidney Disease in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159718. [PMID: 35955072 PMCID: PMC9368667 DOI: 10.3390/ijerph19159718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) is a global health problem. CKD causes patients to be hospitalized for a longer time to treat the disease. The impact of the hospitalization brings major changes and affects the quality of life (QoL) of the patients. In this study, we aimed to evaluate the impact of hospitalization on the QoL of patients with CKD. A cross-sectional study was conducted at the inpatient departments (IPDs) and outpatient departments (OPDs) of selected hospitals, in the eastern region of Saudi Arabia. The kidney disease quality of life (KDQOL) scale was used for the data collection and the findings were analyzed. The hospitalized patients had a poorer QoL than the OPD patients. The physical component summary (PCS) and mental component summary (MCS) mean scores were 52.82 ± 2.32 and 52.57 ± 2.93 in IPD patients, respectively, and 63.46 ± 3.65 and 66.39 ± 0.91 in OPD patients, respectively, which was significant (p < 0.0001). The QoL of patients decreased in the end stages of CKD. A significant association was observed between gender, occupation, smoking, and the stages of CKD with the QoL of the hospitalized patients. Measures must be taken to improve the QoL of these patients at all levels.
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Bailey C, Howell M, Raghunandan R, Salisbury A, Chen G, Coast J, Craig JC, Devlin NJ, Huynh E, Lancsar E, Mulhern BJ, Norman R, Petrou S, Ratcliffe J, Street DJ, Howard K, Viney R. Preference Elicitation Techniques Used in Valuing Children's Health-Related Quality-of-Life: A Systematic Review. PHARMACOECONOMICS 2022; 40:663-698. [PMID: 35619044 PMCID: PMC9270310 DOI: 10.1007/s40273-022-01149-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Valuing children's health states for use in economic evaluations is globally relevant and is of particular relevance in jurisdictions where a cost-utility analysis is the preferred form of analysis for decision making. Despite this, the challenges with valuing child health mean that there are many remaining questions for debate about the approach to elicitation of values. The aim of this paper was to identify and describe the methods used to value children's health states and the specific issues that arise in the use of these methods. METHODS We conducted a systematic search of electronic databases to identify studies published in English since 1990 that used preference elicitation methods to value child and adolescent (under 18 years of age) health states. Eligibility criteria comprised valuation studies concerning both child-specific patient-reported outcome measures and child health states defined in other ways, and methodological studies of valuation approaches that may or may not have yielded a value set algorithm. RESULTS A total of 77 eligible studies were identified from which data on country setting, aims, condition (general population or clinically specific), sample size, age of respondents, the perspective that participants were asked to adopt, source of values (respondents who completed the preference elicitation tasks) and methods questions asked were extracted. Extracted data were classified and evaluated using narrative synthesis methods. The studies were classified into three groups: (1) studies comparing elicitation methods (n = 30); (2) studies comparing perspectives (n = 23); and (3) studies where no comparisons were presented (n = 26); selected studies could fall into more than one group. Overall, the studies varied considerably both in methods used and in reporting. The preference elicitation tasks included time trade-off, standard gamble, visual analogue scaling, rating/ranking, discrete choice experiments, best-worst scaling and willingness to pay elicited through a contingent valuation. Perspectives included adults' considering the health states from their own perspective, adults taking the perspective of a child (own, other, hypothetical) and a child/adolescent taking their own or the perspective of another child. There was some evidence that children gave lower values for comparable health states than did adults that adopted their own perspective or adult/parents that adopted the perspective of children. CONCLUSIONS Differences in reporting limited the conclusions that can be formed about which methods are most suitable for eliciting preferences for children's health and the influence of differing perspectives and values. Difficulties encountered in drawing conclusions from the data (such as lack of consensus and poor reporting making it difficult for users to choose and interpret available values) suggest that reporting guidelines are required to improve the consistency and quality of reporting of studies that value children's health using preference-based techniques.
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Affiliation(s)
- Cate Bailey
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne, VIC, Australia.
| | - Martin Howell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rakhee Raghunandan
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amber Salisbury
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nancy J Devlin
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
| | - Elisabeth Huynh
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Lancsar
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Brendan J Mulhern
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deborah J Street
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rosalie Viney
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
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Rowen D, Mukuria C, Powell PA, Wailoo A. Exploring the Issues of Valuing Child and Adolescent Health States Using a Mixed Sample of Adolescents and Adults. PHARMACOECONOMICS 2022; 40:479-488. [PMID: 35292942 DOI: 10.1007/s40273-022-01133-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Preferences for child and adolescent health states used to generate health state utility values can be elicited from adults, young adults, adolescents, or combinations of these. This commentary paper provides a critical overview of issues and implications arising from valuing child and adolescent health states using a novel approach of a mixed sample of adolescents and adults. The commentary is informed by critical analysis of normative, ethical, practical and theoretical arguments in the health state valuation literature. Discussion focusses upon adolescent empowerment, understanding and psychosocial maturity; ethical concerns; elicitation tasks; perspective; and selection of sample proportions across adolescents and adults. It is argued that valuation of child and adolescent health states by both adolescents and adults could involve all participants completing the same preference elicitation task using the same perspective (e.g. time trade-off imagining they are living in the health state), and all preferences being modelled to generate a combined value set that reflects both adolescent and adult preferences. It is concluded that the valuation of child and adolescent health states by a mixed adolescent and adult sample appears feasible and has the advantage that it includes some of the population who can potentially experience the health states, thus enabling adolescents to express their views around matters that may affect them, and the population that are taxpayers and voters. However, both the relative proportion of adults and adolescents to include in a valuation sample and the elicitation technique require careful consideration.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK.
| | - Clara Mukuria
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK
| | - Philip A Powell
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK
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Alhamed AA, Toly VB, Hooper SR, Dell KM. The link between executive function, socio-emotional functioning and health-related quality of life in children and adolescents with mild to moderate chronic kidney disease. Child Care Health Dev 2022; 48:455-464. [PMID: 34893999 DOI: 10.1111/cch.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and adolescents with mild to moderate chronic kidney disease (CKD) are at high risk for mild but persistent impairment in executive functions, which have been associated with low health-related quality of life (HRQOL) among children and adolescents with chronic health conditions. However, no similar link has been established among children and adolescents with mild to moderate CKD. Given the essential role executive functions play in the development of adequate cognitive, emotional and social skills, it is essential to gain a clearer understating of the magnitude and attributes of executive functions and its link to HRQOL in order to inform appropriate medical and educational interventions for this patient population. OBJECTIVE The aim of this study is to examine the relationship between executive functions, socio-emotional functioning and HRQOL in children and adolescents with mild to moderate CKD. METHODS A cross-sectional design was used for this secondary data analysis of 199 children and adolescents (ages 6-17) with mild to moderate CKD from the United States and Canada who receive care at hospitals associated with the Chronic Kidney Disease in Children Study (CKiD). RESULTS The presence of impairment in executive functions and socio-emotional functioning (internalizing problems) significantly predicted lower HRQOL after controlling for key covariates (i.e., maternal education, anaemia and hypertension). Further, internalizing problems partially mediated the relationship between executive functions and HRQOL such that impairment in executive functions predicted lower HRQOL directly and indirectly by contributing to higher internalizing problems, which further contributed to low HRQOL. CONCLUSION This study underscores the importance of executive functions and socio-emotional functioning in the manifestation of HRQOL. Given that HRQOL is potentially compromised for many children and adolescents with mild to moderate CKD, it will be important for both clinicians and researchers to examine a range of factors, including executive functions and socio-emotional functioning, in order to optimize HRQOL.
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Affiliation(s)
- Arwa A Alhamed
- Nursing Department, College of Nursing, King Saud bin Abdulaizz University for Health Sciences, Riyadh, Saudi Arabia
| | - Valerie B Toly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine M Dell
- Pediatric Institute, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
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De Bruyne E, Eloot S, Vande Walle J, Raes A, Van Biesen W, Goubert L, Vervoort T, Snauwaert E, Van Hoecke E. Validity and reliability of the Dutch version of the PedsQL™ 3.0 End Stage Renal Disease Module in children with chronic kidney disease in Belgium. Pediatr Nephrol 2022; 37:1087-1096. [PMID: 34599378 DOI: 10.1007/s00467-021-05224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) have a low quality of life (QoL). The PedsQL™ 4.0 Generic Core Scales are widely used to assess general QoL in children. The aim of this cross-sectional study was to translate the original version of the CKD-specific PedsQL™ 3.0 End Stage Renal Disease Module into a Dutch version and to evaluate its validity and reliability. METHODS The forward-backward translation method based on the guidelines from the original developer was used to produce the Dutch version of the PedsQL™ 3.0 ESRD Module. Fifty-eight CKD patients (aged 8-18 years) and their parents (n = 31) filled in both generic and disease-specific modules. The non-clinical control group consisted of the same number of healthy children (matched for gender and age) and their parents. RESULTS Cronbach's alpha coefficients (α's) for the PedsQL™ 3.0 ESRD Module demonstrated excellent reliability for the Total Scale scores. For all 7 subscales, α's were greater than 0.60, except for Perceived Physical Appearance. Overall, intercorrelations with the PedsQL™ 4.0 Generic Core Scales were in the medium to large range, supporting construct validity. Parent proxy reports showed lower generic QoL for all domains in CKD patients compared to healthy children. Child self-reports only demonstrated lower QoL on the domain School Functioning in children with CKD compared to healthy children. CONCLUSIONS This study shows good validity and reliability for the Dutch version of the PedsQL™ 3.0 ESRD Module. However, testing with a larger study group is recommended in order to make final conclusions about the psychometric qualities of this measure. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Elke De Bruyne
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
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10
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Pruette CS, Ranch D, Shih WV, Ferris MDG. Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems. Adv Chronic Kidney Dis 2022; 29:318-326. [PMID: 36084978 DOI: 10.1053/j.ackd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.
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Affiliation(s)
| | - Daniel Ranch
- Department of Pediatrics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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11
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Veltkamp F, Teela L, van Oers HA, Haverman L, Bouts AHM. The Use of Patient-Reported Outcome Measures in Daily Clinical Practice of a Pediatric Nephrology Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5338. [PMID: 35564731 PMCID: PMC9102002 DOI: 10.3390/ijerph19095338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: Health-related quality of life (HRQoL) is lower in patients with chronic kidney disease (CKD) compared to the general population. In 2011, the KLIK PROM portal was implemented in the Emma Children's Hospital to monitor and discuss HRQoL in daily care. This study describes and assesses the implementation and use of the KLIK PROM portal in the pediatric nephrology department. (2) Methods: CKD patients (self-report, if 8-18 years of age) and their parents (proxy-report, if 1-8 years) were invited to complete HRQoL patient-reported outcome measures (PROMs): TNO-AZL Preschool children Quality Of Life (TAPQOL) or Pediatric Quality of Life Inventory for Children (PedsQL). The PROMs were completed before and discussed during outpatient consultations. The adaptation rate-the proportion of patients/parents who were invited and completed at least one PROM-was calculated. Reported HRQoL scores of CKD patients were compared to the general population. (3) Results: In total, 142 patients (proxy- and self-report) were invited, 112 patients completed at least one PROM (adaptation rate 79%). Patients (n = 84 with informed consent for scientific use) with CKD reported lower HRQoL and HRQoL was more often impaired compared to the general Dutch population. (4) Conclusions: The implementation of KLIK was successful and its use is feasible for daily care. Using KLIK, HRQoL problems can be easily identified and monitored.
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Affiliation(s)
- Floor Veltkamp
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Lorynn Teela
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (L.T.); (H.A.v.O.); (L.H.)
| | - Hedy A. van Oers
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (L.T.); (H.A.v.O.); (L.H.)
| | - Lotte Haverman
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (L.T.); (H.A.v.O.); (L.H.)
| | - Antonia H. M. Bouts
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
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12
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Jawa NA, Rapoport A, Widger K, Zappitelli M, Davison SN, Jha S, Dart AB, Matsuda-Abedini M. Development of a patient-reported outcome measure for the assessment of symptom burden in pediatric chronic kidney disease (PRO-Kid). Pediatr Nephrol 2022; 37:1377-1386. [PMID: 34761300 PMCID: PMC8579900 DOI: 10.1007/s00467-021-05269-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) and kidney failure in childhood are associated with significant and life-altering morbidities and lower quality of life. Emerging evidence suggests that management should be guided in part by symptom burden; however, there is currently no standardized assessment tool for quantifying symptom burden in this pediatric population. This study aimed to develop and refine a patient-reported symptom assessment tool for children with CKD/kidney failure (PRO-Kid), to evaluate the frequency and impact of symptoms. METHODS This was a prospective observational study of children and caregivers of children with CKD/kidney failure at two Canadian pediatric care centers. Building on previously published patient-reported outcome measures (PROs) for the assessment of symptom burden in other populations, we drafted a 13-item questionnaire. Cognitive interviews were performed with children and caregivers of children with CKD/kidney failure to iteratively refine the questionnaire. RESULTS Twenty-four participants completed cognitive interviewing (11 children, 13 caregivers). The most common symptoms endorsed were feeling left out, feeling sad/depressed, inability to focus, tiredness, nausea, vomiting, not wanting to eat, and changes in the taste of food. Feeling left out was added to the questionnaire as almost all participants voiced this as a frequent and impactful symptom, resulting in a 14-item questionnaire. CONCLUSIONS PRO-Kid is the first pediatric CKD/kidney failure-specific PRO tool to assess symptom burden. Future work should validate this tool in a larger cohort so that it may be used to improve the care of children living with CKD/kidney failure. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Natasha A. Jawa
- grid.42327.300000 0004 0473 9646Division of Nephrology, The Hospital for Sick Children, Toronto, ON Canada
| | - Adam Rapoport
- grid.42327.300000 0004 0473 9646Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON Canada ,Emily’s House Children’s Hospice, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Kimberley Widger
- grid.42327.300000 0004 0473 9646Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada
| | - Michael Zappitelli
- grid.42327.300000 0004 0473 9646Division of Nephrology, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON Canada
| | - Sara N. Davison
- grid.17089.370000 0001 2190 316XDivision of Nephrology and Immunology, University of Alberta, Edmonton, AB Canada
| | - Sarita Jha
- grid.460198.20000 0004 4685 0561Children’s Hospital Research Institute of Manitoba, Winnipeg, MB Canada
| | - Allison B. Dart
- grid.460198.20000 0004 4685 0561Children’s Hospital Research Institute of Manitoba, Winnipeg, MB Canada ,grid.21613.370000 0004 1936 9609Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB Canada
| | - Mina Matsuda-Abedini
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada. .,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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13
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Ruidiaz-Gómez KS, Higuita-Gutiérrez LF. Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis. J Pediatr (Rio J) 2021; 97:478-489. [PMID: 33340460 PMCID: PMC9432262 DOI: 10.1016/j.jped.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument. SOURCES OF DATA A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out. SUMMARY OF THE FINDINGS 17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3-5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the physical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points. CONCLUSION The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the "school" dimension being the most affected and the "emotional" one the least. In this sense, we suggest monitoring the health-related quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease.
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Affiliation(s)
- Keydis Sulay Ruidiaz-Gómez
- University of Antioquia, Faculty of Nursing, Medellin, Colombia; Sinú University Elías Bechara Zainúm, Nursing Program, Cartagena, Colombia.
| | - Luis Felipe Higuita-Gutiérrez
- Cooperative University of Colombia, Faculty of Medicine, Medellin, Colombia; University of Antioquia, School of Microbiology, Medellin, Colombia
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14
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El Amouri A, Snauwaert E, Foulon A, Vande Moortel C, Van Dyck M, Van Hoeck K, Godefroid N, Glorieux G, Van Biesen W, Vande Walle J, Raes A, Eloot S. Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatr Nephrol 2021; 36:1589-1595. [PMID: 33387017 DOI: 10.1007/s00467-020-04840-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) in children is a pro-inflammatory condition leading to a high morbidity and mortality. Accumulation of organic metabolic waste products, coined as uraemic toxins, parallels kidney function decline. Several of these uraemic toxins are protein-bound (PBUT) and gut-derived. Gut dysbiosis is a hallmark of CKD, resulting in a state of increased proteolytic fermentation that might be counteracted by dietary fibre. Data on fibre intake in children with CKD are lacking. We aimed to assess dietary fibre intake in a paediatric CKD cohort and define its relationship with PBUT concentrations. METHODS In this multi-centre, cross-sectional observational study, 61 non-dialysis CKD patients (9 ± 5 years) were included. Dietary fibre intake was assessed through the use of 24-h recalls or 3-day food records and coupled to total and free levels of 4 PBUTs (indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG) and indole acetic acid (IAA). RESULTS In general, fibre intake was low, especially in advanced CKD: 10 ± 6 g/day/BSA in CKD 4-5 versus 14 ± 7 in CKD 1-3 (p = 0.017). Lower concentrations of both total (p = 0.036) and free (p = 0.036) pCG were observed in the group with highest fibre intake, independent of kidney function. CONCLUSIONS Fibre intake in paediatric CKD is low and is even worse in advanced CKD stages. Current dietary fibre recommendations for healthy children are not being achieved. Dietary management of CKD is complex in which too restrictive diets carry the risk of nutritional deficiencies. The relation of fibre intake with PBUTs remains unclear and needs further investigation. Graphical abstract.
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Affiliation(s)
- Amina El Amouri
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Evelien Snauwaert
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Aurélie Foulon
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Charlotte Vande Moortel
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maria Van Dyck
- Paediatric Nephrology Section, Department of Paediatrics, University Hospitals Leuven (campus Gasthuisberg), Herestraat 49, 3000, Leuven, Belgium
| | - Koen Van Hoeck
- Paediatric Nephrology Section, Department of Paediatrics, Antwerp University Hospital, 2650 Edegem, Antwerp, Wilrijkstraat 10, Belgium
| | - Nathalie Godefroid
- Paediatric Nephrology Section, Department of Paediatrics, Cliniques Universitaires St. Luc, Université Catholique Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Johan Vande Walle
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ann Raes
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sunny Eloot
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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15
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Lambourg E, Colvin L, Guthrie G, Murugan K, Lim M, Walker H, Boon G, Bell S. The prevalence of pain among patients with chronic kidney disease using systematic review and meta-analysis. Kidney Int 2021; 100:636-649. [PMID: 33940112 DOI: 10.1016/j.kint.2021.03.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
Pain is a common but often undertreated symptom in patients with chronic kidney disease (CKD) with a much higher prevalence than in the general population. The aim of this systematic review was to synthesize all available quantitative evidence, in order to gain a better understanding of pain prevalence and pain types in patients with CKD. Four databases and the grey literature were searched until 15th January 2021. Random-effect meta-analyses were conducted with multiple subgroup analyses and meta-regressions to further explore the between-study heterogeneity. The quality of studies included was assessed using the Newcastle-Ottawa scale and the level of evidence was determined using the GRADE approach. One hundred sixteen studies reported data on 40,678 individuals. Results from meta-analyses yielded an overall prevalence of 60% (95% confidence interval 56-64) for pain, 48% (42-55) for chronic pain and 10% (6-15) for neuropathic pain. The prevalence of pain was lower among kidney transplant recipients 46% (37-56) compared with patients undergoing dialysis 63% (57-68) and those with non-dialysis CKD 63% (55-70). Musculoskeletal pain appeared to be the most common pain symptom among patients with CKD managed conservatively 42% (28-56) or receiving dialysis 45% (36-55) whilst abdominal pain was most prevalent in kidney transplant recipients 41% (7-86). Thus, all subgroups of patients with CKD suffer from a high burden of pain. Hence, greater awareness and recognition of this issue is vital to inform policy and service provision in this area.
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Affiliation(s)
- Emilie Lambourg
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | - Lesley Colvin
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | | | | | - Michelle Lim
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | - Heather Walker
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK; Renal Unit, Ninewells Hospital, Dundee, UK
| | | | - Samira Bell
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK; Renal Unit, Ninewells Hospital, Dundee, UK.
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16
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El Amouri A, Snauwaert E, Foulon A, Vande Moortel C, Van Dyck M, Van Hoeck K, Godefroid N, Glorieux G, Van Biesen W, Vande Walle J, Raes A, Eloot S. Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease. Toxins (Basel) 2021; 13:toxins13030225. [PMID: 33808581 PMCID: PMC8003569 DOI: 10.3390/toxins13030225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
Imbalanced colonic microbial metabolism plays a pivotal role in generating protein-bound uraemic toxins (PBUTs), which accumulate with deteriorating kidney function and contribute to the uraemic burden of children with chronic kidney disease (CKD). Dietary choices impact the gut microbiome and metabolism. The aim of this study was to investigate the relation between dietary fibre and gut-derived PBUTs in paediatric CKD. Sixty-one (44 male) CKD children (9 ± 5 years) were prospectively followed for two years. Dietary fibre intake was evaluated by either 24-h recalls (73%) or 3-day food records (27%) at the same time of blood sampling for assessment of total and free serum levels of different PBUTs using liquid chromatography. We used linear mixed models to assess associations between fibre intake and PBUT levels. We found an inverse association between increase in fibre consumption (g/day) and serum concentrations of free indoxyl sulfate (−3.1% (−5.9%; −0.3%) (p = 0.035)), free p-cresyl sulfate (−2.5% (−4.7%; −0.3%) (p = 0.034)), total indole acetic acid (IAA) (−1.6% (−3.0%; −0.3%) (p = 0.020)), free IAA (−6.6% (−9.3%; −3.7%) (p < 0.001)), total serum p-cresyl glucuronide (pCG) (−3.0% (−5.6%; −0.5%) (p = 0.021)) and free pCG levels (−3.3% (−5.8%; −0.8%) (p = 0.010)). The observed associations between dietary fibre intake and the investigated PBUTs highlight potential benefits of fibre intake for the paediatric CKD population. The present observational findings should inform and guide adaptations of dietary prescriptions in children with CKD.
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Affiliation(s)
- Amina El Amouri
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
- Correspondence:
| | - Evelien Snauwaert
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Aurélie Foulon
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Charlotte Vande Moortel
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Maria Van Dyck
- Paediatric Nephrology Section, Department of Paediatrics, University Hospitals Leuven (Campus Gasthuisberg), Herestraat 49, 3000 Leuven, Belgium;
| | - Koen Van Hoeck
- Paediatric Nephrology Section, Department of Paediatrics, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium;
| | - Nathalie Godefroid
- Paediatric Nephrology Section, Department of Paediatrics, Cliniques Universitaires St. Luc, Université Catholique Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium;
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Johan Vande Walle
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Ann Raes
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Sunny Eloot
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
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17
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Puma L, Doyle M. Long-term psychosocial outcomes of adults transplanted in childhood: A social work perspective. Pediatr Transplant 2021; 25:e13859. [PMID: 33105051 DOI: 10.1111/petr.13859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022]
Abstract
While much research exists regarding medical outcomes for pediatric end stage renal disease (ESRD) populations and for adults receiving dialysis or kidney transplant, the understanding of long-term psychosocial outcomes for individuals diagnosed with ESRD or transplanted in childhood remains limited. A literature review was undertaken by two social work researchers to identify relationship, education, employment, and quality of life (QOL) outcomes for this population utilizing PUBMED and PsycInfo databases. Inconsistencies in the MeSH terms and keywords used across the relevant articles were noted. The impact of transplantation in childhood is significant across multiple facets of social development including but not limited to peer/intimate relationships, education and employment and QOL, and overall well-being. When compared to healthy peers, those with ESRD were delayed in all areas of social development. While improvements in psychosocial outcomes have occurred alongside improved graft and patient survival, more focused longitudinal and qualitative inquiry is needed. Partnerships are needed across disciplines and across those caring for different age cohorts in pediatric, adult nephrology, and transplant practices.
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Affiliation(s)
- Lynn Puma
- School of Social Work, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Maya Doyle
- Department of Social Work, School of Health Sciences, Quinnipiac University, Hamden, CT, USA
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18
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Logeman C, Guha C, Howell M, Hanson CS, Craig JC, Samuel S, Zappitelli M, Matsuda-Abedini M, Dart A, Furth S, Eddy A, Groothoff J, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Michael M, Walker A, Kausman J, Gaillard S, Bacchetta J, Rheault MN, Warady BA, Neu A, Christian M, McTaggart S, Liu I, Teo S, Sautenet B, Gutman T, Carter S, Teixeira-Pinto A, Tong A. Developing Consensus-Based Outcome Domains for Trials in Children and Adolescents With CKD: An International Delphi Survey. Am J Kidney Dis 2020; 76:533-545. [PMID: 32654889 DOI: 10.1053/j.ajkd.2020.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/08/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE & OBJECTIVE The inconsistency in outcomes reported and lack of patient-reported outcomes across trials in children with chronic kidney disease (CKD) limits shared decision making. As part of the Standardized Outcomes in Nephrology (SONG)-Kids initiative, we aimed to generate a consensus-based prioritized list of critically important outcomes to be reported in all trials in children with CKD. STUDY DESIGN An online 2-round Delphi survey in English, French, and Hindi languages. SETTINGS & PARTICIPANTS Patients (aged 8-21 years), caregivers/family, and health care professionals (HCPs) rated the importance of outcomes using a 9-point Likert scale (7-9 indicating critical importance) and completed a Best-Worst Scale. ANALYTICAL APPROACH We assessed the absolute and relative importance of outcomes. Comments were analyzed thematically. RESULTS 557 participants (72 [13%] patients, 132 [24%] caregivers, and 353 [63%] HCPs) from 48 countries completed round 1 and 312 (56%) participants (28 [40%] patients, 64 [46%] caregivers, and 220 [56%] HCPs) completed round 2. Five outcomes were common in the top 10 for each group: mortality, kidney function, life participation, blood pressure, and infection. Caregivers and HCPs rated cardiovascular disease higher than patients. Patients gave lower ratings to all outcomes compared with caregivers/HCPs except they rated life participation (round 2 mean difference, 0.1), academic performance (0.1), mobility (0.4), and ability to travel (0.4) higher than caregivers and rated ability to travel (0.4) higher than HCPs. We identified 3 themes: alleviating disease and treatment burden, focusing on the whole child, and resolving fluctuating and conflicting goals. LIMITATIONS Most participants completed the survey in English. CONCLUSIONS Mortality, life participation, kidney function, and blood pressure were consistently highly prioritized by patients, caregivers, and HCPs. Patients gave higher priority to some lifestyle-related outcomes compared with caregivers/HCPs. Establishing critically important outcomes for all trials in children with CKD may improve consistent reporting of survival, kidney health, and clinical and life impact outcomes that are meaningful for decision making.
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Affiliation(s)
- Charlotte Logeman
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, Canada
| | - Mina Matsuda-Abedini
- Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Furth
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA; Department of Epidemiology, Perelman School of Medicine, Philadelphia, PA; Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison Eddy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Detlef Bockenhauer
- UCL Department of Renal Medicine and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Debbie S Gipson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Mini Michael
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Amanda Walker
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Nephrology and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Joshua Kausman
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Nephrology and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Segolene Gaillard
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, Bron, France
| | - Justine Bacchetta
- Department of Pediatric Nephrology, Reference Center for Rare Renal Diseases, Hospices civils de Lyon, Lyon, France
| | - Michelle N Rheault
- Division of Nephrology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | | | - Alicia Neu
- Division of Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Steven McTaggart
- Child and Adolescent Renal Service, Queensland Children's Hospital and University of Queensland, Brisbane, Australia
| | - Isaac Liu
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Sharon Teo
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Benedicte Sautenet
- Department of Nephrology Hypertension, dialysis, kidney transplantation, Tours Hospital, SPHERE - INSERM 1246, University of Tours and Nantes, Tours, France
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Simon Carter
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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19
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Evaluation of administrative case definitions for chronic kidney disease in children. Pediatr Res 2020; 87:569-575. [PMID: 31578037 DOI: 10.1038/s41390-019-0595-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Administrative data is increasingly used for chronic disease surveillance; however, its validity to define cases of chronic kidney disease (CKD) in children is unknown. We sought to evaluate the performance of case definitions for CKD in children. METHODS We utilized population-based administrative data from the Manitoba Center for Health Policy to evaluate the validity of algorithms based on a combination of hospital claims, outpatient physician visits, and pharmaceutical use over 1-3 years in children <18 years of age. Algorithms were compared with a laboratory-based definition (estimated glomerular filtration rate < 90 ml/min/1.73 m2 and/or presence of proteinuria). RESULTS All algorithms evaluated had very low sensitivity (0.20-0.39) and moderate positive predictive value (0.52-0.68). Algorithms had excellent specificity (0.98-0.99) and negative predictive value (0.96-0.97). Receiver operating characteristic (ROC) curves indicate fair accuracy (0.60-0.68). Sensitivity improved with increasing years of data. One or more physician claims and one or more prescriptions over 3 years had the highest sensitivity and ROC. CONCLUSIONS The sensitivity of administrative data algorithms for CKD is unacceptably low for a screening test. Specificity is excellent; therefore, children without CKD are correctly identified. Alternate data sources are required for population-based surveillance of this important chronic disease.
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20
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Shaikh N, Rajakumar V, Peterson CG, Gorski J, Ivanova A, Gravens Muller L, Miyashita Y, Smith KJ, Mattoo T, Pohl HG, Mathews R, Greenfield SP, Docimo SG, Hoberman A. Cost-Utility of Antimicrobial Prophylaxis for Treatment of Children With Vesicoureteral Reflux. Front Pediatr 2019; 7:530. [PMID: 31998668 PMCID: PMC6965145 DOI: 10.3389/fped.2019.00530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Antimicrobial prophylaxis for children with vesicoureteral reflux (VUR) reduces recurrences of urinary tract infection (UTI) but requires daily antimicrobials for extended periods. We used a cost-utility model to evaluate whether the benefits of antimicrobial prophylaxis outweigh its risks and, if so, to investigate whether the benefits and risks vary according to grade of VUR. Methods: We compared the cost per quality-adjusted life-year (QALY) gained in four treatment strategies in children aged <6 years diagnosed with VUR after a first UTI, considering these treatment strategies: (1) prophylaxis for all children with VUR, (2) prophylaxis for children with Grade III or Grade IV VUR, (3) prophylaxis for children with Grade IV VUR, and (4) no prophylaxis. Costs and effectiveness were estimated over the patient's lifetime. We used $100,000/QALY gained as the threshold for considering a treatment strategy cost effective. Results: Based on current data and plausible ranges to account for data uncertainty, prophylaxis of children with Grades IV VUR costs $37,903 per QALY gained. Treating children with Grade III and IV VUR costs an additional $302,024 per QALY gained. Treating children with all grades of VUR costs an additional $339,740 per QALY gained. Conclusions: Treating children with Grades I, II, and III VUR with long-term antimicrobial prophylaxis costs substantially more than interventions typically considered economically reasonable. Prophylaxis in children with Grade IV VUR is cost effective.
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Affiliation(s)
- Nader Shaikh
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Vinod Rajakumar
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States
| | - Caitlin G Peterson
- Nephrology, University of Utah Health, Salt Lake City, UT, United States
| | - Jillian Gorski
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Anastasia Ivanova
- Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa Gravens Muller
- Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yosuke Miyashita
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kenneth J Smith
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tej Mattoo
- Nephrology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Hans G Pohl
- Children's National Medical Center, Washington, DC, United States
| | - Ranjiv Mathews
- Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Saul P Greenfield
- Department of Pediatrics and Urology, Zucker School of Medicine, New York, NY, United States
| | - Steven G Docimo
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Alejandro Hoberman
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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21
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Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England. PLoS One 2018; 13:e0207960. [PMID: 30475893 PMCID: PMC6258125 DOI: 10.1371/journal.pone.0207960] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/08/2018] [Indexed: 12/21/2022] Open
Abstract
Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated with other non-communicable chronic diseases including diabetes. However, there is limited information on a population basis of the relationship between CKD and health-related quality of life (HRQoL) and the consequent economic cost. We investigated this relationship in a representative sample in England using the 2010 Health Survey for England. Multivariable Tobit models were used to examine the relationship between HRQoL and CKD severity. HRQoL was converted to quality adjusted life year (QALY) measures by combining decrements in quality of life with reductions in life expectancy associated with increased disease severity. QALYs were adjusted for discounting and monetised using the UK threshold for reimbursement of £30,000. The QALYs were then used in conjunction with forecasted prevalence to estimate the HRQoL burden associated with CKD among individuals with diabetes up to 2025. Individuals with more severe CKD had lower HRQoL compared to those with better kidney function. Compared to those with normal/low normal kidney function and stage 1 CKD, those with stage 2, stage 3 with albuminuria and stage 4/5 CKD experienced a decrement of 0.11, 0.18 and 0.28 in their utility index, respectively. Applying the UK reimbursement threshold for a QALY, the monetised lifetime burden of reduced HRQoL due to stage 2, stage 3 with albuminuria and stage 4/5 CKD were £103,734; £83,399; £125,335 in males and £143,582; £70,288; £203,804 in females, respectively. Utilizing the predicted prevalence of CKD among individuals with diabetes mellitus, the economic burden of CKD per million of individuals with diabetes is forecasted at approximately £11.4 billion in 2025. In conclusion, CKD has a strong adverse impact on HRQoL in multiple domains. The estimated economic burden of CKD among individuals with diabetes mellitus in the UK is projected to rise markedly over time.
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22
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Lee SY, Shin H. [Self-Management Experiences of the Adolescents with Chronic Kidney Disease]. J Korean Acad Nurs 2018; 48:266-278. [PMID: 29968683 DOI: 10.4040/jkan.2018.48.3.266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to develop a substantive theory on self-management conducted by the adolescents with chronic kidney disease from their lived experience. METHODS Data was collected through in-depth interviews from May to December in 2015 with thirteen adolescents with chronic kidney disease. The data collected were analyzed on the basis of Strauss and Corbin's grounded theory. RESULTS The core of the category found in this study was "overcoming the unstable sense of self-control and integrating disease experience into their life". The causal conditions triggering the central phenomenon were "restriction in daily life" and "manifestation and aggravation of symptom". The central phenomenon in the experience of self-management within the adolescents with chronic kidney disease was "unstable sense of self control". The intervening condition for unstable self control were "micro system support" and "motivational resources". This study found that the adolescents with chronic kidney disease followed a series of strategies when they faced the central phenomenon, including; passive coping, reappraisal of illness, active coping, compliance with treatment, controlling physical activity, and adjusting school life. With these strategic approaches, the adolescents with chronic kidney disease could maintain their active lifestyles and achieve their health behaviors. The process of self-management by these adolescents passed through four phases; limited experience caused by diseases, effort for normalization, reorganizing their daily lives, and integration with daily lives and self-management. CONCLUSION This Study explored the process and experience of self-management of adolescents with chronic kidney disease. These findings can be used for basis for developing substantive theory and nursing intervention strategy for adolescents with chronic kidney diseases.
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Affiliation(s)
- Sug Young Lee
- Hanil University & Presbyterian Theological Seminary, Wanju, Korea
| | - Heesun Shin
- College of Nursing, Dankook University, Cheonan, Korea.
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23
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Snauwaert E, Van Biesen W, Raes A, Glorieux G, Vanholder R, Vande Walle J, Eloot S. A plea for more uremic toxin research in children with chronic kidney disease. Pediatr Nephrol 2018; 33:921-924. [PMID: 29500629 DOI: 10.1007/s00467-018-3920-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Evelien Snauwaert
- Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Sciences, Ghent University, Administratie Pediatrie 3K12D Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Paediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | | | - Johan Vande Walle
- Department of Paediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
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24
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Souza MAD, Melo LDL. Being adolescent with chronic renal failure: a view through existential phenomenology. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2017-0368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To understand adolescent's experiences with chronic renal failure disease, attended in a pubic teaching hospital at São Paulo state. Method: Phenomenological study, based on the philosophical reference of Martin Heidegger, with six adolescents interviewed by the following question: "What is it like to be an adolescent with chronic renal failure?" Results: Three ontological categories emerged: feeling different; experiencing renal insufficiency through renal replacement therapy; seeking normality. Conclusion: It was evidenced that the experiences of these adolescents were demonstrated by their behaviors of acceptance and denial, both related to chronic renal failure as a peculiar condition of their lives. Implications for practice: It is crucial that nursing directs a more careful look at adolescents with chronic renal failure, going beyond the disease and also considering the particularities of the adolescents necessary to face the adversities that arise from this experience.
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25
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Mihardja L, Delima D, Massie RGA, Karyana M, Nugroho P, Yunir E. Prevalence of kidney dysfunction in diabetes mellitus and associated risk factors among productive age Indonesian. J Diabetes Metab Disord 2018; 17:53-61. [PMID: 29984211 PMCID: PMC6013541 DOI: 10.1007/s40200-018-0338-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 02/12/2018] [Indexed: 12/16/2022]
Abstract
Background The prevalence of diabetes mellitus is increasing in Indonesia due to population growth, urbanization, and lifestyle. Diabetes mellitus (DM) is the leading cause of chronic kidney disease that escalates mortality rate, but not all DM develop into chronic kidney disease. Aims To estimate the prevalence of kidney dysfunction (KD) in DM and the associated dominant risk factors among productive age Indonesian based on the National Health Survey (Riskesdas) 2013. Methods The statistical data consisted of 15,791 females and 10,349 males, aged 20 to 54, who lived in rural and urban areas. The data was obtained from National Institute of Health Research and Development (NIHRD), Ministry of Health. Data were collected from 33 provinces using cross sectional method. The variables data analyzed were sociodemographic, lifestyle, anthropometric, blood pressure, blood lipid, blood glucose, and creatinine. Kidney dysfunction was defined according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Multivariable logistic regression was used to analyze the dominant associated risk factors. Results The prevalence of KD in DM was 4% (CI 95% 3.1-5.1) and only 0.6% had been diagnosed. Many associated risk factors could affect DM leading to KD such as age, sex, rural, economic status, sugary food/drinks, salty food, coffee, hypertension, hypercholesterolemia, low HDL, high LDL, and hypertriglyceridemia. The dominant associated risk factors were age, sex, economic status, sugary food/drinks, and low HDL. Conclusion The prevalence of KD in DM among productive age Indonesian was 4% and only 0.6% had been diagnosed. Early detection of identification of KD in DM is needed in order to slow progression and complications. The dominant associated risk factors of KD in DM were age, sex, economic status, sugary food/drinks, and low HDL. Controlling of risk factors in DM should be done in order to prevent diabetic kidney disease.
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Affiliation(s)
- Laurentia Mihardja
- 1National Institute of Health Research and Development, Ministry of Health, Percetakan Negara no 29, Jakarta, Indonesia
| | - Delima Delima
- 1National Institute of Health Research and Development, Ministry of Health, Percetakan Negara no 29, Jakarta, Indonesia
| | - Roy G A Massie
- 1National Institute of Health Research and Development, Ministry of Health, Percetakan Negara no 29, Jakarta, Indonesia
| | - Muhammad Karyana
- 1National Institute of Health Research and Development, Ministry of Health, Percetakan Negara no 29, Jakarta, Indonesia
| | - Pringgodigdo Nugroho
- 2Department of Internal Medicine, Medical Faculty, University of Indonesia, Jakarta, Indonesia
| | - Em Yunir
- 2Department of Internal Medicine, Medical Faculty, University of Indonesia, Jakarta, Indonesia
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26
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Willig L, Paquette E, Hester DM, Warady BA, Lantos JD. Parents Refusing Dialysis for a 3-Month-Old With Renal Failure. Pediatrics 2018; 141:peds.2017-2096. [PMID: 29490907 DOI: 10.1542/peds.2017-2096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 11/24/2022] Open
Abstract
A 3-month-old boy with failure to thrive was referred to a nephrology clinic after a diagnostic workup for failure to thrive revealed a serum urea nitrogen level of 95 mg/dL and creatinine level of 3.6 mg/dL. A renal ultrasound revealed marked bilateral hydronephrosis with little remaining renal cortex in either kidney. A voiding cystourethrogram revealed evidence of posterior urethral valves. The child had no evident comorbidities. Fulguration of the valves was successfully performed but did not lead to improvement in kidney function. The nephrologists recommended the initiation of dialysis with the hope that the child would be able to receive a kidney transplant in the future. After careful consideration, the family stated that they did not want this child to suffer with a lifetime of dialysis and transplant care. They were also concerned about the impact of this child's illness on their other 2 children and their family. They requested that their son be provided with palliative care only. Experts in nephrology, bioethics, and critical care discuss the ethical issues raised by this parental request.
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Affiliation(s)
| | - Erin Paquette
- Division of Critical Care, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and
| | - D Micah Hester
- Division of Medical Humanities, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Kansas City, Kansas City, Missouri;
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27
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Bruggers CS, Baranowski S, Beseris M, Leonard R, Long D, Schulte E, Shorter A, Stigner R, Mason CC, Bedrov A, Pascual I, Bulaj G. A Prototype Exercise-Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases. Front Pediatr 2018; 6:69. [PMID: 29686977 PMCID: PMC5900044 DOI: 10.3389/fped.2018.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer. METHODS Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed. RESULTS A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars! CONCLUSION Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.
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Affiliation(s)
- Carol S Bruggers
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Primary Children's Hospital, Salt Lake City, UT, United States
| | | | | | | | - Derek Long
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | | | | | - Rowan Stigner
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | - Clinton C Mason
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Alisa Bedrov
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Ian Pascual
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States.,Juan Diego Catholic High School, Draper, UT, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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28
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Hamilton AJ, Clissold RL, Inward CD, Caskey FJ, Ben-Shlomo Y. Sociodemographic, Psychologic Health, and Lifestyle Outcomes in Young Adults on Renal Replacement Therapy. Clin J Am Soc Nephrol 2017; 12:1951-1961. [PMID: 29051144 PMCID: PMC5718271 DOI: 10.2215/cjn.04760517] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/02/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Young adults receiving RRT face additional challenges in life. The effect of established kidney failure on young adulthood is uncertain. We aimed to establish the psychosocial and lifestyle status of young adults receiving RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our study was a systematic review and meta-analysis of 16-30-year olds receiving RRT compared with the general population. We selected randomized, controlled trials; cohort studies; or cross-sectional studies without language restriction and extracted proportions of sociodemographic and lifestyle outcomes or validated psychologic health tests producing quality of life, wellbeing, and self-esteem scores. We undertook random effects meta-analysis. RESULTS There were 60 studies with a total of 15,575 participants. Studies were largely single-center cross-sectional studies of those transplanted in childhood. Compared with healthy peers, young adults on RRT had lower quality of life, which was worse for patients on dialysis (seven studies: standardized mean difference, -1.01; 95% confidence interval [95% CI], -1.32 to -0.70) compared with patients with transplants (nine studies: standardized mean difference, -0.42; 95% CI, -0.64 to -0.20). They were more likely to be unemployed (seven studies: relative risk, 1.89; 95% CI, 1.47 to 2.44) and live in the family home (two studies: relative risk, 1.84; 95% CI, 1.40 to 2.43). They were less likely to be married or have a partner (four studies: relative risk, 0.71; 95% CI, 0.53 to 0.95). Higher education (three studies: relative risk, 1.05; 95% CI, 0.73 to 1.51), alcohol abstinence (three studies: relative risk, 1.96; 95% CI, 0.84 to 4.67), and smoking status (two studies: relative risk, 0.72; 95% CI, 0.36 to 1.44) did not differ. Results were limited by high heterogeneity and a small evidence base, biased toward surviving patients. CONCLUSIONS Established kidney failure is associated with lower quality of life in young people and limited employment, independence, and relationships compared with healthy peers. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_10_19_CJASNPodcast_17_12_.mp3.
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Affiliation(s)
- Alexander J. Hamilton
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom
| | - Rhian L. Clissold
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom; and
| | - Carol D. Inward
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Fergus J. Caskey
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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29
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Baek HS, Kang HG, Choi HJ, Cheong HI, Ha IS, Han KH, Kim SH, Cho HY, Shin JI, Park YS, Lee JH, Lee J, Ahn C, Cho MH. Health-related quality of life of children with pre-dialysis chronic kidney disease. Pediatr Nephrol 2017; 32:2097-2105. [PMID: 28685173 DOI: 10.1007/s00467-017-3721-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the quality of life (QOL) of Asian children with pre-dialysis chronic kidney disease (CKD) and to reveal the factors influencing the QOL of children with CKD. METHODS We performed a cross-sectional study of the PedsQL 4.0 Generic Core Scale Module in the KNOW-PedCKD (KoreaN cohort study for Outcome in patients with Pediatric Chronic Kidney Disease) cohort, and compared the child self-reported and parent proxy-reported QOL of the pediatric cohort. From 2011 through 2016, a total of 376 children with CKD were enrolled after informed consent was obtained from parents or caregivers in seven pediatric nephrology centers. RESULTS In parent proxy-reports, male patients had a better QOL than female patients in the Physical Functioning category. In child self-reports, male patients had better QOL than female patients in the Physical, Emotional, and School Functioning categories. According to CKD stage, there were significant differences in the QOL score in all categories of parent proxy-reports, and patients with higher CKD stage (lower glomerular filtration rate) had a worse QOL. Growth parameters showed a significantly positive correlation with the QOL score in all categories. CONCLUSIONS The QOL of children with predialysis CKD is affected by various factors, including sex, glomerular filtration rate (GFR), socio-economic status, existence of co-morbidities, anemia, growth retardation, and behavioral disorders. To improve their QOL, it is important to objectively understand the respective effects of these factors and attempt early intervention.
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Affiliation(s)
- Hee Sun Baek
- Department of Pediatrics, Kyungpook National University Children's Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Kyung Hee Han
- Department of Pediatrics, Jeju University Hospital, Jeju, South Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, South Korea
| | - Hee Yeon Cho
- Department of Pediatrics, Samsung Medical Center, Seoul, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Severance Children's Hospital, Seoul, South Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center, Seoul, South Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center, Seoul, South Korea
| | - Joongyub Lee
- Department of Preventive Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University Children's Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea.
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Aymé S, Bockenhauer D, Day S, Devuyst O, Guay-Woodford LM, Ingelfinger JR, Klein JB, Knoers NVAM, Perrone RD, Roberts J, Schaefer F, Torres VE, Cheung M, Wheeler DC, Winkelmayer WC. Common Elements in Rare Kidney Diseases: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2017; 92:796-808. [PMID: 28938953 PMCID: PMC6685068 DOI: 10.1016/j.kint.2017.06.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 12/14/2022]
Abstract
Rare kidney diseases encompass at least 150 different conditions, most of which are inherited. Although individual rare kidney diseases raise specific issues, as a group these rare diseases can have overlapping challenges in diagnosis and treatment. These challenges include small numbers of affected patients, unidentified causes of disease, lack of biomarkers for monitoring disease progression, and need for complex care. To address common clinical and patient issues among rare kidney diseases, the KDIGO Controversies Conference entitled, Common Elements in Rare Kidney Diseases, brought together a panel of multidisciplinary clinical providers and patient advocates to address five central issues for rare kidney diseases. These issues encompassed diagnostic challenges, management of kidney functional decline and progression of chronic kidney disease, challenges in clinical study design, translation of advances in research to clinical care, and provision of practical and integrated patient support. Thus, by a process of consensus, guidance for addressing these challenges was developed and is presented here.
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Affiliation(s)
- Ségolène Aymé
- Institut du Cerveau et de la Moelle Épinière, Centre National de la Recherche Scientifique Unite Mixte de Recherche 7225, Institut National de la Santé et de la Recherche Médicale U 1127, Université Pierre et Marie Curie-P6 Unite Mixte de Recherche S 1127, Paris, France
| | - Detlef Bockenhauer
- University College of London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - Simon Day
- Clinical Trials Consulting and Training Limited, Buckingham, UK
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System, Washington, DC, USA.
| | - Julie R Ingelfinger
- MassGeneral Hospital for Children at Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jon B Klein
- Division of Nephrology and Hypertension, The University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald D Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Julia Roberts
- Polycystic Kidney Disease Foundation, Kansas City, Missouri, USA
| | - Franz Schaefer
- Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, Heidelberg, Germany
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes, Brussels, Belgium
| | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Chong LSH, Sautenet B, Tong A, Hanson CS, Samuel S, Zappitelli M, Dart A, Furth S, Eddy AA, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Raman G, Craig JC. Range and Heterogeneity of Outcomes in Randomized Trials of Pediatric Chronic Kidney Disease. J Pediatr 2017; 186:110-117.e11. [PMID: 28449820 DOI: 10.1016/j.jpeds.2017.03.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/07/2017] [Accepted: 03/10/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the range and heterogeneity of outcomes reported in randomized controlled trials of interventions for children with chronic kidney disease (CKD). STUDY DESIGN The Cochrane Kidney and Transplant Specialized Register was searched to March 2016. Randomized trials involving children across all stages of CKD were selected. All outcome domains and measurements were extracted from included trials. The frequency and characteristics of the outcome domains and measures were evaluated. RESULTS From 205 trials included, 6158 different measurements of 100 different outcome domains were reported, with a median of 22 domains per trial (IQR 13-41). Overall, 52 domains (52%) were surrogate, 38 (38%) were clinical, and 10 (10%) were patient-reported. The 5 most commonly reported domains were blood pressure (76 [37%] trials), relapse/remission (70 [34%]), kidney function (66 [32%]), infection (61 [30%]), and height/pubertal development (51 [25%]). Mortality (14%), cardiovascular disease (4%), and quality of life (1%) were reported infrequently. The 2 most frequently reported outcomes, blood pressure and relapse/remission, had 56 and 81 different outcome measures, respectively. CONCLUSIONS The outcomes reported in clinical trials involving children with CKD are extremely heterogeneous and are most often surrogate outcomes, rather than clinical and patient-centered outcomes such as cardiovascular disease and quality of life. Efforts to ensure consistent reporting of outcomes that are important to patients and clinicians will improve the value of trials to guide clinical decision-making. In our study, non-English articles were excluded.
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Affiliation(s)
- Lauren S H Chong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France; INSERM (U1153), Paris, France
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia and the British Columbia Children's Hospital, Vancouver, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Pediatric Nephrology and National Institute for Health Research/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Detlef Bockenhauer
- University College London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Gayathri Raman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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32
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Oh TR, Kim CS, Bae EH, Ma SK, Han SH, Sung SA, Lee K, Oh KH, Ahn C, Kim SW. Association between vitamin D deficiency and health-related quality of life in patients with chronic kidney disease from the KNOW-CKD study. PLoS One 2017; 12:e0174282. [PMID: 28448520 PMCID: PMC5407618 DOI: 10.1371/journal.pone.0174282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/06/2017] [Indexed: 12/25/2022] Open
Abstract
Vitamin D deficiency is a growing health problem in both the general population and in patients with chronic kidney disease (CKD). However, the relationship between serum 25-hydroxyvitamin D levels and health-related quality of life in CKD is not well established. This study examined the association between vitamin D deficiency and quality of life in pre-dialysis CKD patients. Serum 25-hydroxyvitamin D levels and the Korean version of the Kidney Disease Quality of Life short form were obtained for 1844 pre-dialysis CKD patients in the prospective KoreaN cohort Study for Outcomes in patients With Chronic Kidney Disease (KNOW-CKD). The baseline estimated glomerular filtration rate was 50.26 ± 0.71 mL/min/1.73 m2. We identified 1294 (70.2%) patients with vitamin D deficiency, defined as a 25-hydroxyvitamin D level < 20 ng/ml. The scores of the kidney disease component summary, physical component summary, and mental component summary in the vitamin D deficiency group were significantly lower compared to the scores of those without vitamin D deficiency. The serum 25-hydroxyvitamin D level was independently associated with the kidney disease component summary and mental component summary scores (β = 0.147, p = 0.003 and β = 0.151, p = 0.047). In conclusion, there was a significant association between serum 25-hydroxyvitamin D levels and kidney disease component summary and mental component summary scores in pre-dialysis CKD patients.
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Affiliation(s)
- Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hyeok Han
- Depatment of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su-Ah Sung
- Department of Internal Medicine, Eulji University, Seoul, Korea
| | - Kyubeck Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Kook Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Lung T, Howard K, Etherton-Beer C, Sim M, Lewin G, Arendts G. Comparison of the HUI3 and the EQ-5D-3L in a nursing home setting. PLoS One 2017; 12:e0172796. [PMID: 28234983 PMCID: PMC5325524 DOI: 10.1371/journal.pone.0172796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/09/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Accurately assessing changes in the quality of life of older people living permanently in nursing homes is important. The multi-attribute utility instrument most commonly used and recommended to assess health-related quality of life in the nursing home population is the three-level EuroQol EQ-5D-3L. To date, there have been no studies using the Health Utilities Index Mark III (HUI3). The purpose of this study was to compare the level of agreement and sensitivity to change of the EQ-5D-3L and HUI3 in a nursing home population. METHODS EQ-5D-3L and HUI3 scores were measured as part of a cluster randomised controlled trial of nurse led care coordination in a nursing home population in Perth, Western Australia at baseline and 6-month follow up. RESULTS Both measures were completed for 199 residents at baseline and 177 at 6-month follow-up. Mean baseline utility scores for EQ-5D-3L (0.45; 95% CI 0.41-0.49) and HUI3 (0.15; 95% CI 0.10-0.20) were significantly different (Wilcoxon signed rank test, p<0.01) and agreement was poor to moderate between absolute scores from each instrument (intra-class correlation coefficient = 0.63). The EQ-5D-3L appeared more sensitive to change over the 6-month period. CONCLUSION Our findings show that the EQ-5D-3L and HUI3 estimate different utility scores among nursing home residents. These differences should be taken into account, particularly when considering the implications of the cost-effectiveness of particular interventions and we conclude that the HUI3 is no better suited to measuring health-related quality of life in a nursing home population when compared to the EQ-5D-3L.
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Affiliation(s)
- Tom Lung
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney Medical School, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology Royal Perth Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Gill Lewin
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Glenn Arendts
- Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia
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Variation in estimated glomerular filtration rate at dialysis initiation in children. Pediatr Nephrol 2017; 32:331-340. [PMID: 27695987 DOI: 10.1007/s00467-016-3483-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data guiding the timing of dialysis initiation in children are limited. We sought to determine current practice and secular trends in Canada with respect to the timing of dialysis initiation in children based on estimated glomerular filtration rate (eGFR). METHODS This observational study included incident chronic dialysis patients aged ≤21 years identified from the Canadian Organ Replacement Register who started dialysis in Canada between January 2001 and December 2010 at any of the nine participating Canadian centers (n = 583). Youth were categorized utilizing CKiD Schwartz eGFR into ≥10.5 (higher) or <10.5 ml/min/1.73 m2 (lower) eGFR groups. Differences at dialysis initiation by facility and region were examined, and secular trends were determined. RESULTS Median eGFR at dialysis initiation was 8.1 (interquartile range 5.4-11.0) ml/min/1.73 m2. Overall, 29 % of the patients started dialysis with an eGFR of ≥10.5 ml/min/1.73 m2. The proportion of children starting with higher eGFR increased from 27.3 % in 2001 to 35.4 % in 2010 (p = 0.04) and differed by treatment facility (12-70 %; p = 0.0001). Factors associated with higher eGFR at dialysis initiation in the adjusted regression model were female sex [odds ratio (OR) 1.48; 95 % confidence interval (CI) 1.02-2.14], genetic cause of end-stage kidney disease (OR 2.77; 95 % CI 1.37-5.58) and living ≥50 km from treatment facility (OR 1.47; 95 % CI 1.01-2.14). CONCLUSIONS One-third of the children were found to have initiated dialysis with an eGFR ≥10.5 ml/min/1.73 m2, however significant practice variation exists with respect to timing of dialysis initiation by treatment facility. More data is required to evaluate the clinical implications of this practice variation.
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Mohammad S. Budesonide as first-line therapy for non-cirrhotic autoimmune hepatitis in children: a decision analysis. Scand J Gastroenterol 2016; 51:753-62. [PMID: 26762679 DOI: 10.3109/00365521.2015.1130166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Therapy for autoimmune hepatitis has been prednisone based for decades; however, budesonide may be equally effective with fewer side effects. Our aim was to evaluate quality-adjusted life years and health care costs of three different treatment regimens. MATERIALS AND METHODS Treatment using prednisone, budesonide or a combination of both over a three-year period in newly diagnosed children with type I autoimmune hepatitis were simulated with a Markov model. Transition probabilities were calculated over consecutive three-month period. Costs were determined from a hospital database and health utilities were estimated from the literature. A Monte Carlo probabilistic sensitivity analysis was used to simulate the outcomes of 5000 patients in each treatment arm. RESULTS Compared to standard therapy, budesonide leads to a gain of 0.09 quality-adjusted life years, costing $17,722 per QALY over a three-year period. Standard therapy led to significantly lower QALY's compared to other strategies (p < 0.001). Health utilities of patients in remission in each treatment group had the greatest impact on the model. Budesonide remained the treatment of choice if the probability of inducing remission was 55% or greater. CONCLUSIONS Budesonide therapy in non-cirrhotic, treatment naïve patients with type I autoimmune hepatitis yielded greater QALY's compared to the current standard therapy with an acceptable increase in costs.
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Affiliation(s)
- Saeed Mohammad
- a Department of Pediatrics , Feinberg School of Medicine, Northwestern University , 225 E Chicago Ave , Chicago , IL , USA
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36
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Crump RT, Beverung LM, Lau R, Sieracki R, Nicholson M. Reliability, Validity, and Feasibility of Direct Elicitation of Children's Preferences for Health States. Med Decis Making 2016; 37:314-326. [PMID: 27694286 DOI: 10.1177/0272989x16671925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children's preferences for health states represent an important perspective when comparing the value of alternative health care interventions related to pediatric medicine, and are fundamental to comparative effectiveness research. However, there is debate over whether these preference data can be collected and used. PURPOSE The purpose of this study was to establish psychometric properties of eliciting preferences for health states from children using direct methods. DATA SOURCES Ovid Medline, PsycINFO, Scopus, EconLit. STUDY SELECTION English studies, published after 1990, were identified using Medical Subject Headings or keywords. Results were reviewed to confirm that the study was based on: 1) a sample of children, and 2) preferences for health states. DATA EXTRACTION Standardized data collection forms were used to record the preference elicitation method used, and any reported evidence regarding the validity, reliability, or feasibility of the method. DATA SYNTHESIS Twenty-six studies were ultimately included in the analysis. The standard gamble and time tradeoff were the most commonly reported direct preference elicitation methods. Seven studies reported validity, four reported reliability, and nine reported feasibility. Of the validity reports, construct validity was assessed most often. Reliability reports typically involved interclass correlation coefficient. For feasibility, four studies reported completion rates. LIMITATIONS The search was limited to four databases and restricted to English studies published after 1990. Only evidence available in published studies were considered; measurement properties may have been tested in pilot or pre-studies but were not published, and are not included in this review. CONCLUSION The few studies found through this systematic review demonstrate that there is little empirical evidence on which to judge the use of direct preference elicitation methods with children regarding health states.
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Affiliation(s)
- R Trafford Crump
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (RTC, LMB, RL, RS, MN)
| | - Lauren M Beverung
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (RTC, LMB, RL, RS, MN)
| | - Ryan Lau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (RTC, LMB, RL, RS, MN)
| | - Rita Sieracki
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (RTC, LMB, RL, RS, MN)
| | - Mateo Nicholson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (RTC, LMB, RL, RS, MN)
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Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol 2016; 31:1579-91. [PMID: 26310616 PMCID: PMC4995226 DOI: 10.1007/s00467-015-3186-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022]
Abstract
Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide strategies for incorporation of HRQoL assessment into clinical practice. Studies report that pediatric patients with ESRD have significantly lower HRQoL scores compared with children with other chronic diseases. Patients treated by dialysis are at particularly high risk for impaired HRQoL. Furthermore, patients more often have impaired neurocognitive functioning and lower academic achievement. Important determinants of impaired HRQoL include medical factors (i.e., receiving dialysis, disabling comorbidities, cosmetic side effects, stunted growth), sociodemographic factors (i.e., female gender, non-Western background) and psychosocial factors (i.e., noneffective coping strategies). Contrary to the situation in childhood, adult survivors of pediatric ESRD report a normal mental HRQoL. Despite this subjective feeling of well-being, these patients have on average experienced significantly more difficulties in completing their education, developing intimate relationships, and securing employment. Several medical and psychosocial strategies may potentially improve HRQoL in children with ESRD. Regular assessment of HRQoL and neurocognitive functioning in order to identify areas in which therapies and interventions may be required should be part of standard clinical care.
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Affiliation(s)
- Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Chong L, Jamieson NJ, Gill D, Singh-Grewal D, Craig JC, Ju A, Hanson CS, Tong A. Children's Experiences of Epilepsy: A Systematic Review of Qualitative Studies. Pediatrics 2016; 138:peds.2016-0658. [PMID: 27511947 DOI: 10.1542/peds.2016-0658] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Epilepsy is a common and severe neurologic disease associated with increased mortality, seizure-related injury, and adverse psychological and quality-of-life outcomes. OBJECTIVE To describe the perspectives of children and adolescents with epilepsy. DATA SOURCES Medline, Embase, PsycINFO, and CINAHL from inception to August 2015. STUDY SELECTION Qualitative studies on children's experiences of epilepsy. DATA EXTRACTION Results from primary studies. We used thematic synthesis to analyze the findings. RESULTS Forty-three articles involving 951 participants aged 3 to 21 years across 21 countries were included. We identified 6 themes: loss of bodily control (being overtaken, susceptibility to physical harm, fragility of the brain, alertness to mortality, incapacitating fatigue), loss of privacy (declarative disease, humiliating involuntary function, unwanted special attention, social embarrassment of medicine-taking), inescapable inferiority and discrimination (vulnerability to prejudice, inability to achieve academically, consciousness of abnormality, parental shame, limiting social freedom), therapeutic burden and futility (unattainable closure, financial burden, overwhelming life disruption, exhaustion from trialing therapies, insurmountable side effects, awaiting a fabled remission), navigating health care (empowerment through information, valuing empathetic and responsive care, unexpected necessity of transition, fragmented and inconsistent care), and recontextualizing to regain normality (distinguishing disease from identity, taking ownership, gaining perspective and maturity, social and spiritual connectedness). LIMITATIONS Non-English articles were excluded. CONCLUSIONS Children with epilepsy experience vulnerability, disempowerment, and discrimination. Repeated treatment failure can raise doubt about the attainment of remission. Addressing stigma, future independence, and fear of death may improve the overall well-being of children with epilepsy.
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Affiliation(s)
- Lauren Chong
- Sydney School of Public Health and Kids Research Institute
| | | | | | - Davinder Singh-Grewal
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia; Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; and School of Maternal and Child Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Angela Ju
- Sydney School of Public Health and Kids Research Institute
| | | | - Allison Tong
- Sydney School of Public Health and Kids Research Institute,
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Taylan C, Schlune A, Meissner T, Ažukaitis K, Udink Ten Cate FEA, Weber LT. Disease control via intensified lipoprotein apheresis in three siblings with familial hypercholesterolemia. J Clin Lipidol 2016; 10:1303-1310. [PMID: 27919346 DOI: 10.1016/j.jacl.2016.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/13/2016] [Accepted: 08/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH), the prevalent monogenic form of hypercholesterolemia, carries the risk of premature coronary heart disease. Lipoprotein-apheresis is established in children with severe dyslipidemia. We present 3 siblings with a negative/negative residual low-density lipoprotein (LDL) receptor mutation (p.Trp577Arg), unresponsive to drug treatment. OBJECTIVE Intensified lipoprotein-apheresis is well tolerated and results in permanently low lipid values without harming the health-related quality of life in children. METHODS Three homozygous FH siblings, aged 7-13 years, had been treated with statins and ezetimibe for 12 months but still showed highly elevated low-density lipoprotein cholesterol (LDL-C) plasma concentrations. They were started on double-filtration plasmapheresis that was subsequently intensified according to plasma lipid levels. RESULTS Each lipoprotein apheresis session reduced LDL-C concentration by 66% to 70%. Treated plasma volume was doubled after 6 months due to a sustained rebound of LDL-C between sessions. However, the rebound remained unchanged. Only an increase in frequency of sessions to every 3 to 4 days resulted in acceptable pre-treatment LDL-C concentrations (Cmax). Neither cessation of statins nor reduction of plasma exchange volume to 1.5 fold in follow-up influenced Cmax. Intensified therapy did not harm health-related quality of life as assessed by PedsQL and was well tolerated. CONCLUSIONS In pediatric FH patients unresponsive to drug treatment, intensified lipoprotein apheresis can normalize plasma lipid levels. Apparently, treatment frequency rather than volume has greater influence on its efficacy. The potential burden of intensified therapy to daily life has to be regarded. Serum lipid levels in FH should be normalized to minimize cardiovascular risk.
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Affiliation(s)
- Christina Taylan
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany.
| | - Andrea Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Düsseldorf, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Düsseldorf, Germany
| | - Karolis Ažukaitis
- Pediatric Nephrology, Vilnius University-Hospital, Vilnius, Lithuania
| | - Floris E A Udink Ten Cate
- Department of Pediatric Cardiology, Heart Center Cologne, University Hospital of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
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Tong A, Samuel S, Zappitelli M, Dart A, Furth S, Eddy A, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Hanson CS, Evangelidis N, Crowe S, Harris T, Hemmelgarn BR, Manns B, Gill J, Tugwell P, Van Biesen W, Wheeler DC, Winkelmayer WC, Craig JC. Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids): a protocol for establishing a core outcome set for children with chronic kidney disease. Trials 2016; 17:401. [PMID: 27519274 PMCID: PMC4982996 DOI: 10.1186/s13063-016-1528-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/26/2016] [Indexed: 01/03/2023] Open
Abstract
Background Children with chronic kidney disease (CKD), requiring dialysis or kidney transplantation, have a mortality rate of up to 30-fold higher than the general aged-matched population, and severely impaired quality of life. Symptoms such as fatigue and pain are prevalent and debilitating. Children with CKD are at risk of cognitive impairment, and poorer educational, vocational, and psychosocial outcomes compared with their well peers, which have consequences through to adulthood. Treatment regimens for children with CKD are long-term, complex, and highly intrusive. While many trials have been conducted to improve outcomes in children with CKD, the outcomes measured and reported are often not relevant to patients and clinicians, and are highly variable. These problems can diminish the value of trials as a means to improve the lives of children with CKD. The Standardised Outcomes in Nephrology—Children and Adolescents (SONG-Kids) study aims to develop a core outcome set for trials in children and adolescents with any stage of CKD that is based on the shared priorities of all stakeholders. Methods/Design SONG-Kids involves five phases: a systematic review to identify outcomes (both domains and measures) that have been reported in randomised controlled trials involving children aged up to 21 years with CKD; focus groups (using nominal group technique) with adolescent patients and caregivers of paediatric patients (all ages) to identify outcomes that are relevant and important to patients and their family and the reasons for their choices; semistructured key informant interviews with health professionals involved in the care of children with CKD to ascertain their views on establishing core outcomes in paediatric nephrology; an international three-round online Delphi survey with patients, caregivers, clinicians, researchers, policy-makers, and members from industry to develop consensus on important outcome domains; and a stakeholder workshop to review and finalise the set of core outcome domains for trials in children with CKD (including nondialysis-dependent, dialysis, and kidney transplantation). Discussion Establishing a core outcome set to be reported in all trials conducted in children with any stage of CKD will enhance the relevance, transparency, and impact of research to improve the lives of children and adolescents with CKD.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia.
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine and Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison Eddy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Paediatric Nephrology and NIHR/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Detlef Bockenhauer
- UCL Centre for Nephrology and Great Ormond Street Hospital for Children NHS Foundation Trus, London, UK
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | | | | | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
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Browne T, Amamoo A, Patzer RE, Krisher J, Well H, Gander J, Pastan SO. Everybody needs a cheerleader to get a kidney transplant: a qualitative study of the patient barriers and facilitators to kidney transplantation in the Southeastern United States. BMC Nephrol 2016; 17:108. [PMID: 27476111 PMCID: PMC4967312 DOI: 10.1186/s12882-016-0326-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Kidney transplantation (KTx) disparity is a significant problem in the United States, particularly in the Southeastern region. In response to this phenomenon, the Southeastern Kidney Transplant Coalition was created in 2011 to increase the KTx rate, and to reduce disparities in access to transplantation in the Southeast, by identifying and reducing barriers in the transplant process. METHODS To determine perceived barriers and facilitators to KTx that dialysis patients in this region experience, we conducted three focus groups with 40 total patients in Georgia, North Carolina, and South Carolina. RESULTS We identified two novel themes specific to Southeastern dialysis patients that describe the major barriers and facilitators to kidney transplantation: dialysis center approaches to patient education about KTx, and dialysis center advocacy and encouragement for KTx. In addition, themes related to barriers and facilitators of KTx were evident that were previously mentioned in the literature such as age, fear, knowing other patients with good or bad experiences with KTx, distrust of the KTx process equity, financial concerns and medical barriers. CONCLUSIONS Dialysis providers are encouraged to enhance their delivery of information and active assistance to underserved patients related to KTx.
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Affiliation(s)
- Teri Browne
- College of Social Work, University of South Carolina, 12 Hamilton, Columbia, SC, 29208, USA.
| | - Ahinee Amamoo
- Southeastern Kidney Council, 1000 St. Albans Drive, Suite 270, Raleigh, NC, 27609, USA
| | - Rachel E Patzer
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
| | - Jenna Krisher
- Southeastern Kidney Council, 1000 St. Albans Drive, Suite 270, Raleigh, NC, 27609, USA
| | - Henry Well
- National Kidney Foundation, 508 Hampton Street, Columbia, SC, 29201, USA
| | - Jennifer Gander
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
| | - Stephen O Pastan
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
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AlBuhairan F, Nasim M, Al Otaibi A, Shaheen NA, Al Jaser S, Al Alwan I. Health related quality of life and family impact of type 1 diabetes among adolescents in Saudi Arabia. Diabetes Res Clin Pract 2016; 114:173-9. [PMID: 26830857 DOI: 10.1016/j.diabres.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 11/12/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Abstract
AIM To measure the health related quality of life (HRQoL) among Saudi Arabian adolescents with type 1 diabetes mellitus (T1DM) and the impact the disease has on the family. METHODOLOGY A cross sectional study was conducted involving 315 adolescent patients (12-18 years) and their caregivers. Adolescent HRQoL was assessed by adolescents and their parents completing the Peds QL™ Diabetes Module 3.0. Family impact was assessed by the parent completing the Peds QL™ Family Impact module (FIM). RESULTS Adolescents reported a cumulative mean HRQoL score of 64.8, while parents reported significantly lower scores of 60.3 (p=0.003). The lowest scores reported by both adolescents and parents were for "Worry". Female gender and late adolescent age were predictors of lower HRQoL for adolescents with T1DM. The FIM showed low scores for "Emotional functioning" (59.8) and high scores for "Family relationships" (80.9). CONCLUSION These findings emphasize the importance of an interdisciplinary, biopsychosocial and family centered care approach to adolescents with a chronic disease. Future work could assess the effectiveness of direct care involvement of adolescent and mental health experts in improving the HRQoL for this population.
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Affiliation(s)
- Fadia AlBuhairan
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia.
| | - Maliha Nasim
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahlam Al Otaibi
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| | - Naila A Shaheen
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Al Jaser
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Internal Medicine, King AbdulAziz Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Al Alwan
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
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Hourani EM, Hammad SM, Shaheen A, Amre HM. Health-Related Quality of Life Among Jordanian Adolescents. Clin Nurs Res 2016; 26:337-353. [PMID: 26896245 DOI: 10.1177/1054773815626667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Adolescence is an unpredictable stage of life with varied and rapid changes. In Jordan, health-related quality of life (HRQoL) has been examined among diabetic and obese children and adolescents. The purpose of this study was to assess the HRQoL of Jordanian healthy adolescents. Three hundred fifty-four male and female adolescents whose ages ranged from 12 to 19 participated in the study. A descriptive comparative design was employed to investigate adolescents' HRQoL. The results revealed statistically significant differences in physical well-being, psychosocial well-being, and autonomy in favor of male adolescents. In addition, statistically significant differences were observed in favor of nonsmoker adolescents in psychosocial well-being, self-perception, parent relations and home life, financial resources, social relations and peers and school environment. In conclusion, the creation of a school health nurse role in Jordanian schools is crucial for helping adolescents improve their health.
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Tong A, Gow K, Wong G, Henning P, Carroll R. Patient perspectives of a young adult renal clinic: a mixed-methods evaluation. Nephrology (Carlton) 2016; 20:352-9. [PMID: 25641116 DOI: 10.1111/nep.12396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/30/2022]
Abstract
AIM We aimed to evaluate a young adult renal clinic (YAC) intervention that included a multidisciplinary clinic and social programme. METHODS Semi-structured interviews and surveys (Kidney Disease Quality of Life (KDQOL)-36, Time Trade-Off (TTO) and Morisky 8-Item Medication Adherence Questionnaire) were conducted with 15 patients aged 18 to 26 years with chronic kidney disease Stages 1-5, 5D and 5T before and after they attended two YACs. RESULTS We identified six themes: gaining confidence (encouraging self-expression, exchanging experiential knowledge, helping others, positive reflection and optimism); social connectedness; appreciating a welcoming environment; competing priorities; avoiding the sick identity; and relational boundaries. There were no significant improvements in the overall utility-based quality of life (QOL) scores (TTO: 0.72 (standard deviation (SD): 0.34) and 0.76 (SD: 0.30), P = 0.70) and the proportion of participants achieving medium to high medication adherence (n = 7, 46.7% vs n = 8, 53.3%, P = 0.72). Similar findings were observed for KDQOL domains. CONCLUSION The impact of the YAC on QOL and adherence is unclear. However, patients can develop coping mechanisms and derive psychosocial benefits such as optimism. Some are conscious about respecting the privacy of others or want to disassociate themselves from the 'disease'. Strategies to strengthen rapport, confidence and sense of 'normality' and to destigmatize the illness may enhance the effectiveness of a YAC.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Brkovic T, Burilovic E, Puljak L. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review. Patient Prefer Adherence 2016; 10:1131-50. [PMID: 27382261 PMCID: PMC4922783 DOI: 10.2147/ppa.s103927] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Understanding the epidemiology of pain in patients on hemodialysis (HD) is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. MATERIALS AND METHODS We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool. RESULTS We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain. CONCLUSION The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients' quality of life and pain-related disability.
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Affiliation(s)
- Tonci Brkovic
- Department of Internal Medicine, Division of Nephrology
| | | | - Livia Puljak
- Department of Anatomy, Histology and Embryology, Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
- Correspondence: Livia Puljak, Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia, Tel +385 21 557 807, Fax +385 21 557 811, Email
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Chen G, Ratcliffe J. A Review of the Development and Application of Generic Multi-Attribute Utility Instruments for Paediatric Populations. PHARMACOECONOMICS 2015; 33:1013-28. [PMID: 25985933 DOI: 10.1007/s40273-015-0286-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Multi-attribute utility instruments (MAUIs) are increasingly being used as a means of quantifying utility for the calculation of quality-adjusted life-years within the context of cost utility analysis. Traditionally, MAUIs have been developed and applied in adult populations. However, increasingly, researchers in health economics and other disciplines are recognising the importance of the measurement and valuation of health in both children and adolescents. Presently, there are nine generic MAUIs available internationally that have been used in paediatric populations: the Quality of Well-Being Scale (QWB), the Health Utility Index Mark 2 (HUI2), the HUI3, the Sixteen-dimensional measure of health-related quality of life (HRQoL) (16D), the Seventeen-dimensional measure of HRQoL (17D), the Assessment of Quality of Life 6-Dimension (AQoL-6D) Adolescent, the Child Health Utility 9D (CHU9D), the EQ-5D Youth version (EQ-5D-Y) and the Adolescent Health Utility Measure (AHUM). This paper critically reviews the development and application of the above nine MAUIs and discusses the specific challenges of health utility measurement in children and adolescents. Areas for further research relating to the development and application of generic MAUIs in paediatric populations are highlighted.
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Affiliation(s)
- Gang Chen
- Flinders Health Economics Group, School of Medicine, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Julie Ratcliffe
- Flinders Clinical Effectiveness, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Casey JR, Hanson CS, Winkelmayer WC, Craig JC, Palmer S, Strippoli GFM, Tong A. Patients' perspectives on hemodialysis vascular access: a systematic review of qualitative studies. Am J Kidney Dis 2014; 64:937-53. [PMID: 25115617 DOI: 10.1053/j.ajkd.2014.06.024] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/12/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Delayed creation of vascular access may be due in part to patient refusal and is associated with adverse outcomes. Concerns about vascular access are prevailing treatment-related stressors for patients on hemodialysis therapy. This study aims to describe patients' perspectives on vascular access initiation and maintenance in hemodialysis. STUDY DESIGN Systematic review and thematic synthesis of qualitative studies. SETTING & POPULATION Patients with chronic kidney disease who express opinions about vascular access for hemodialysis. SEARCH STRATEGY & SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL, reference lists, and PhD dissertations were searched to October 2013. ANALYTICAL APPROACH Thematic synthesis was used to analyze the findings. RESULTS From 46 studies involving 1,034 patients, we identified 6 themes: heightened vulnerability (bodily intrusion, fear of cannulation, threat of complications and failure, unpreparedness, dependence on a lifeline, and wary of unfamiliar providers), disfigurement (preserving normal appearance, visual reminder of disease, and avoiding stigma), mechanization of the body (bonded to a machine, internal abnormality, and constant maintenance), impinging on way of life (physical incapacitation, instigating family tension, wasting time, and added expense), self-preservation and ownership (task-focused control, advocating for protection, and acceptance), and confronting decisions and consequences (imminence of dialysis therapy and existential thoughts). LIMITATIONS Non-English articles were excluded. CONCLUSIONS Vascular access is more than a surgical intervention. Initiation of vascular access signifies kidney failure and imminent dialysis, which is emotionally confronting. Patients strive to preserve their vascular access for survival, but at the same time describe it as an agonizing reminder of their body's failings and "abnormality" of being amalgamated with a machine disrupting their identity and lifestyle. Timely education and counseling about vascular access and building patients' trust in health care providers may improve the quality of dialysis and lead to better outcomes for patients with chronic kidney disease requiring hemodialysis.
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Affiliation(s)
- Jordan R Casey
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia
| | | | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia
| | | | - Giovanni F M Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Medical Scientific Office, Diaverum, Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia.
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Abstract
Children with chronic kidney disease stage 5 requiring dialysis can be treated by peritoneal or hemodialysis. In the United Kingdom nearly twice as many children receive peritoneal dialysis compared with hemodialysis. Technical aspects of pediatric hemodialysis are challenging and include the relative size of extracorporeal circuit and child's blood volume, assessment of adequacy,technical and complications of vascular access. Alternatives to standard hospital-based hemodialysis are also increasingly available. Optimizing nutritional status with the support of specialist pediatric dietitians is key to the management of children receiving hemodialysis. The effects of chronic illness on growth and school achievement, as well as the psychological, emotional, and social development of the child should not be underestimated. This review focuses on the above elements and highlights common pediatric practice in the United Kingdom.
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Affiliation(s)
- Amrit Kaur
- Birmingham Childrens' Hospital, Birmingham, UK
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50
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Wong G, Medway M, Didsbury M, Tong A, Turner R, Mackie F, McTaggart S, Walker A, White S, Howard K, Kim S, Craig JC. Health and wealth in children and adolescents with chronic kidney disease (K-CAD study). BMC Public Health 2014; 14:307. [PMID: 24708535 PMCID: PMC4233636 DOI: 10.1186/1471-2458-14-307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 11/30/2022] Open
Abstract
Background The impact of reduced kidney function in children is substantial. End-stage kidney disease (ESKD), the most severe form of chronic kidney disease (CKD), is a devastating illness associated with substantially increased mortality, impaired growth and psychosocial maladjustment in children. Understanding how to address the complex causes of mortality and morbidity in children with CKD requires explicit information about the risk factors that lead to adverse outcomes. In addition to biological influences, the socioeconomic circumstances of caregivers may play a significant role in the health and well-being of children with CKD. Methods/Design A prospective cohort study (n = 380 children and n = 380 caregivers) will be conducted to determine the prevalence of economic hardship among caregivers of children with CKD. All participants will be followed biennially over a period of 5 years to determine the association between the changing socioeconomic status of the caregivers and the health and overall well-being of school-aged children with CKD. Face to face, semi-structured interviews with the caregivers (n = 45) will also be conducted to understand their perspectives on the economic, financial and psychosocial impact of CKD and how this affects the health outcomes of their child with CKD. The primary outcomes of the study are the effects of the socioeconomic status of the caregivers and self-reported health status of the children. Secondary outcomes included the prevalence of economic hardship and the distribution of wealth among the caregivers of children with CKD. Discussion Findings from this study presents not only a snapshot of the current economic and social situation of the caregivers of children and adolescents with CKD but will also provide definitive evidence of determining whether a link between socioeconomic status of caregivers and outcomes of children with CKD exists.
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Affiliation(s)
- Germaine Wong
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, Australia.
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