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Bell LE, Ferris ME, Fenton N, Hooper SR. Health care transition for adolescents with CKD-the journey from pediatric to adult care. Adv Chronic Kidney Dis 2011; 18:384-90. [PMID: 21896381 DOI: 10.1053/j.ackd.2011.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 04/10/2011] [Accepted: 04/26/2011] [Indexed: 11/11/2022]
Abstract
The design of Health Care Transition (HCT) services for adolescents and emerging adults with CKD or end-stage kidney disease (ESKD) needs to take into account patient cognition/developmental stage, family factors, and health resources within the hospital setting and community. Patient and family education is fundamental and teaching and learning tools must be literacy-accessible. Adolescents and emerging adults with CKD/ESDK have complex medical and dietary regimes, and therapeutic adherence is important for optimizing their health, quality of life, and longevity. Health providers need to identify ways of engaging them to become successful disease self-mangers. Interdisciplinary collaboration between the pediatric- and adult-focused health care teams and the services of a dedicated transition coordinator are paramount to ensure clear communication between the patient and the health professionals involved. Valid measurement tools to monitor and assess the HCT process and health outcomes need to be developed. The aims of planned HCT for adolescents and/or emerging adults with CKD/ESKD are anchored by the goals of optimizing health outcomes, health-related quality of life, and continuous quality improvement. The care of young people with CKD/ESKD can be both challenging and rewarding; we offer strategies for planned HCT services geared to these vulnerable patients.
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Brunelli G, Nogueira PCK, Pestana JOM, Diniz DHMP. Quality of life in children on dialysis. Int Urol Nephrol 2011; 44:1515-9. [PMID: 21870089 DOI: 10.1007/s11255-011-0047-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In recent years, the survival of patients with end stage renal disease (ESRD) has increased but few studies have assessed the quality of life in children on dialysis. The aim of the present cross-sectional study was to analyze the quality of life in this pediatric population and compare it with healthy controls using the Autoquestionnaire Qualité de Vie Enfant Image. SUBJECTS Thirty-three children on dialysis paired for gender, age, and social level with 33 healthy children. RESULTS A significant difference was observed between the groups regarding the question on the practicing of sports. For this question, 29/33 healthy children reported to be very satisfied, while only 17/33 out of the ESRD group stated likewise. When asked about satisfaction of the children at the table with the family, 23/33 of the controls and 16/33 of the ESRD group reported to be very satisfied, showing a trend toward a significant difference (P = 0.059). No differences were observed for the remaining questions. We conclude that ESRD was linked to lower perception of quality of life in leisure aspects (sports) and a trend regarding functional issues (meal at the table).
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Affiliation(s)
- Giovanna Brunelli
- Discipline of Nephrology, Department of Medicine, Federal University of São Paulo, Escola Paulista de Medicina, Rua Botucatu, 740, São Paulo, São Paulo CEP 04023-900, Brazil.
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Abstract
Kidney transplantation is the treatment of choice for the majority of pediatric patients with end-stage kidney disease. Previous studies demonstrating racial or gender disparities in access to the deceased donor transplant list could not evaluate the impact of medical concerns or patient preference on waitlist status. We undertook a retrospective cohort study using the NAPRTCS registry to begin to determine barriers to wait list registration for kidney transplantation among pediatric dialysis patients. Clinical and demographic factors were compared in listed vs. non-listed patients. Reasons cited for not listing patients were examined by clinical and demographic factors. At dialysis initiation, 88.7% of pediatric dialysis patients were not on the renal transplant wait list. Twelve months after dialysis initiation, 67.1% of pediatric dialysis patients were not on the wait list. The groups least likely to be on the wait list were infants (adjusted OR 0.23, 95% CI 0.16, 0.32) and girls (adjusted OR 0.78, 95% CI 0.67, 0.90) after adjusting for multiple confounders. The reason most often cited for not listing was medical reason for young infants and that the transplant workup was pending for girls. Further study is needed to identify barriers to wait list registration.
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Limbers CA, Neighbors K, Martz K, Bucuvalas JC, Webb T, Varni JW, Alonso EM. Health-related quality of life in pediatric liver transplant recipients compared with other chronic disease groups. Pediatr Transplant 2011; 15:245-53. [PMID: 21199214 PMCID: PMC3078219 DOI: 10.1111/j.1399-3046.2010.01453.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This cross-sectional, multicenter cohort study compares the level of HRQOL of pediatric LT recipients to children with other chronic health conditions. LT sample included 873 children who survived at least 12 months following LT. Six chronic disease samples were compiled from numerous studies, including over 800 patients with JRA, type 1 diabetes, cancer in remission, cardiac disease, end-stage renal disease, and inflammatory bowel disease. Generic HRQOL was measured from both the parental and patient perspective using the PedsQL™ 4.0 Generic Core Scales. Pediatric LT patients reported better physical health than children with JRA. According to parents, pediatric LT recipients had better HRQOL than children on renal dialysis on all domains except school functioning. Across all domains but emotional functioning, pediatric LT recipients reported significantly lower HRQOL than children with type 1 diabetes. Overall, pediatric LT patients reported HRQOL comparable to that of children who had undergone renal transplantation and patients with cancer in remission. Pediatric LT patients manifested impaired HRQOL similar to that of children with chronic diseases and these data suggest that they face ongoing challenges that warrant monitoring and indicate a need for interventions to improve their HRQOL.
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Pakpour AH, Yekaninejad M, Molsted S, Harrison AP, Hashemi F, Saffari M. Translation, cultural adaptation assessment, and both validity and reliability testing of the Kidney Disease Quality of Life--Short Form version 1.3 for use with Iranian patients. Nephrology (Carlton) 2011; 16:106-12. [PMID: 21175986 DOI: 10.1111/j.1440-1797.2010.01389.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aims of the study were to translate the Kidney Disease Quality of Life--Short Form version 1.3 (KDQOL-SF ver. 1.3) questionnaire into Iranian (Farsi), and to then assess it in terms of validity and reliability on Iranian patients. METHODS The questionnaire was first translated into Farsi by two independent translators, and then subsequently translated back into English. After translation disparities had been reconciled, the final Iranian questionnaire was tested. An initial test-retest reliability evaluation was performed over a 10 day period on a sample of 20 patients recruited from a larger group (212 patients with end-stage renal disease on haemodialysis). Afterwards, reliability was estimated by internal consistency, and validity was assessed using known group comparisons and constructs for the patient group as a whole. Finally, the factor structure of the questionnaire was extracted by performing exploratory factor analysis. RESULTS All of the scales in the questionnaire showed good test-retest reliability (i.e. intraclass correlations between test and retest scores were >0.7). All of the scales met the minimal criteria (0.7) for internal consistency and Cronbach's-α ranged 0.71-0.93. Furthermore, results from a discriminate validity evaluation showed that the questionnaire could be used to discriminate between subgroups of the patients. Finally, a principal component analysis of the disease-specific scales indicated that this part of the questionnaire could be summarized into an 11 factor structure that jointly accounted for 79.81% of the variance. CONCLUSION The Iranian version of the KDQOL-SF questionnaire is both highly reliable and valid for use with Iranian patients on haemodialysis.
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Affiliation(s)
- Amir H Pakpour
- Department of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran.
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Behavioral disorders and low quality of life in children and adolescents with chronic kidney disease. Pediatr Nephrol 2011; 26:281-90. [PMID: 21110044 DOI: 10.1007/s00467-010-1683-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/12/2010] [Accepted: 08/24/2010] [Indexed: 10/18/2022]
Abstract
Recent years has seen an increasing interest in the quality of life (QOL) of children with chronic kidney disease (CKD). The objective of this cross-sectional study was to investigate the prevalence of behavioral disorders and to assess the health-related QOL (HRQOL) in 136 patients with CKD. To estimate the prevalence of behavior disorders and analyze HRQOL, we used the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Inventory of Quality of Life (PedsQL) Core Scales as assessment tools for both the patients and caregivers. When compared to healthy controls, the CKD group had significantly lower scores in almost all PedsQL domains. After adjustment, only absence of religion/other religions remained significantly associated with a lower global HRQOL score [odds ratio (OR) 6.2, P=0.009]. Among the parents, two factors remained significantly associated with a lower global HRQOL score: patients' age >10 years (OR 5.4, P=0.033) and absence of religion/other religions (OR 3.2, P=0.038). The CKD group demonstrated a higher proportion of behavioral and emotional disorders in all SDQ domains. There was a negative correlation between the presence of behavior and emotional disorders and HRQOL score (r= -0.552, P<0.001). Our findings suggest the importance of evaluating behavioral and social repercussions of CKD in order to improve the life quality of this pediatric population.
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Diseth TH, Tangeraas T, Reinfjell T, Bjerre A. Kidney transplantation in childhood: mental health and quality of life of children and caregivers. Pediatr Nephrol 2011; 26:1881-92. [PMID: 21520007 PMCID: PMC3163767 DOI: 10.1007/s00467-011-1887-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 01/14/2023]
Abstract
Our objective was to assess the mental health and health-related quality of life (HRQOL) in children and their parents after renal transplantation (TX) compared to healthy controls and children with acute lymphoblastic leukemia (ALL) and to identify possible health status variables associated with impaired mental health and HRQOL. Thirty-eight TX children with a median age of 13 (range 3-19) years were investigated. Mental health was assessed by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the Strength and Difficulties Questionnaire (SDQ-20). Each mother's own mental health and QOL were assessed by the General Health Questionnaire (GHQ-30) and the Quality of Life Scale (QOLS). Forty children with ALL [median age 11 (8.5-15.4) years] and 42 healthy children [median age 11 (8.9- 15) years] served as controls. Treadmill exercise results from 22 of the 38 patients were included in the analysis. TX children showed significantly higher levels of mental health problems and lower HRQOL at 2 to 16 years after transplantation compared to both control groups. Body mass index and maximal oxygen uptake (n = 22/38) were significant predictors of child mental health (SDQ) and child QOL (PedsQL), respectively. Based on these results, we suggest that rehabilitation after TX should include a focus on physical activity and QOL to reduce interconnected physical and psychological morbidity in kidney TX children.
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Affiliation(s)
- Trond H. Diseth
- grid.55325.340000000403898485Department of Clinical Neurosciences for Children, Women and Children’s Division, Oslo University Hospital and University of Oslo, Oslo, Norway ,grid.55325.340000000403898485Barne- og ungdomspsykiatrisk seksjon, Barneklinikken, Oslo universitetssykehus HF, Rikshospitalet, PO Box 4950, Nydalen, NO-0424 Oslo Norway
| | - Trine Tangeraas
- grid.55325.340000000403898485Department of Paediatric Medicine, Women and Children’s Division, Oslo University Hospital, Oslo, Norway
| | - Trude Reinfjell
- grid.52522.320000000406273560Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Anna Bjerre
- grid.55325.340000000403898485Department of Paediatric Medicine, Women and Children’s Division, Oslo University Hospital, Oslo, Norway
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Dodson JL, Furth SL, Yenokyan G, Alcorn K, Diener-West M, Wu AW, Gearhart JP. Parent perspectives of health related quality of life for adolescents with bladder exstrophy-epispadias as measured by the child health questionnaire-parent form 50. J Urol 2010; 184:1656-61. [PMID: 20728103 DOI: 10.1016/j.juro.2010.03.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE Few groups have examined health related quality of life for adolescents with bladder exstrophy-epispadias. We studied parent reported health related quality of life for adolescents with bladder exstrophy-epispadias using the Child Health Questionnaire-Parent Form 50. MATERIALS AND METHODS We recruited 11 to 17-year-old participants with bladder exstrophy-epispadias and their parents. Parents served as proxy respondents for the adolescents by self-administering a validated generic health related quality of life instrument, the Child Health Questionnaire-Parent Form 50. We collected urinary incontinence, catheterization status, and medical and surgical history data. Mean questionnaire scores were compared to population based norms. RESULTS Median age of the 55 patients was 14 years, 69% were male and 84% were white. Diagnoses included bladder exstrophy in 48 cases and epispadias in 7. Of the participants 29 (53%) reported urinary incontinence. The median number of lifetime surgeries was 9. Although physical and psychosocial summary measure scores were comparable to norms, the mean general health perception score was significantly worse than that of a population based sample (65.8 points, 95% CI 61.4-70.2 vs 73, 95% CI 71.3-74.7, p = 0.004). Mean family activity and parent emotional impact scores were also significantly worse than in a population based sample (83.6 points, 95% CI 79.3-88.0 vs 89.7, 95% CI 87.9-91.5, p = 0.02 and 67.7, 95% CI 61.9-73.6 vs 80.3, 95% CI 78.4-82.2, p <0.0001, respectively). Comparison of incontinent to continent children revealed a lower mean score on the parent emotional impact scale (62.6 points, 95% CI 55.5-69.8 vs 73.4, 95% CI 63.9-82.9), which approached significance (p = 0.06). CONCLUSIONS Although overall adolescent quality of life was comparable to norms, parents reported significantly impaired adolescent general health and family activity as well as a negative parental emotional impact. Further research is needed to identify interventions that can decrease the adverse impact of bladder exstrophy-epispadias on family activity and parent emotional distress.
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Affiliation(s)
- Jennifer L Dodson
- Department of Urology, Johns Hopkins Medical Institutions, Marburg144, 600 North Wolfe St., Baltimore, Maryland 21287-2101, USA.
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Wiedebusch S, Konrad M, Foppe H, Reichwald-Klugger E, Schaefer F, Schreiber V, Muthny FA. Health-related quality of life, psychosocial strains, and coping in parents of children with chronic renal failure. Pediatr Nephrol 2010; 25:1477-85. [PMID: 20461533 DOI: 10.1007/s00467-010-1540-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/08/2010] [Accepted: 03/22/2010] [Indexed: 11/26/2022]
Abstract
Health-related quality of life (HRQOL) in parents of children suffering from renal disease is often diminished by the illness burden experienced in daily life and by unfavorable ways of coping. Our aim was to examine the relationship between psychosocial strains perceived by parents, their ways of coping, and HRQOL. In an anonymous cross-sectional study, parents completed a questionnaire concerning psychosocial strains, coping strategies, and HRQOL, as well as sociodemographic and illness parameters. Study participants were recruited in two outpatient dialysis centers. Participating in the study were 195 parents (105 mothers, 90 fathers; age 43 +/- 8 years; representing 108 families) of children suffering from renal disease (age 12 +/- 5 years). Parents of children with chronic renal failure reported moderate HRQOL with parents of children undergoing dialysis experiencing more limitations in quality of life than parents of children living with a kidney graft and parents of children undergoing conservative treatment. Mothers experienced lower HRQOL and higher psychosocial strains than fathers. HRQOL was predicted by the coping strategies "focusing on child" (beta = -0.25), "improving marital relationship" (beta = 0.24), "seeking social support" (beta = -0.22) and "self-acceptation and growth" (beta =0 .19) as well as parents' perceived limitation by illness in daily life (beta = -0.15; explained variance 57%). In the comprehensive care for families with a child suffering from a renal disease, screening for psychosocial strains and ways of coping, along with applying interventions to strengthen adaptive coping strategies, may be a preventative means of improving parents' quality of life.
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Affiliation(s)
- Silvia Wiedebusch
- Department of Medical Psychology, University Hospital of Muenster, Germany.
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Quality of life in children with chronic kidney disease (with child and parent assessments). Pediatr Nephrol 2010; 25:1487-96. [PMID: 20383649 DOI: 10.1007/s00467-010-1486-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 01/25/2010] [Accepted: 01/27/2010] [Indexed: 02/05/2023]
Abstract
Herein the results of a multicenter study from the Turkish Pediatric Kidney Transplantation Study Group are reported. The aims of this study were to compare the quality of life (QoL) scores of Turkish children who are dialysis patients (DP), renal transplant recipients (TR), and age-matched healthy controls and to compare child-self and parent-proxy scores. The Turkish versions of the Kinder Lebensqualität Fragebogen (KINDL(R)) questionnaires were used as a QoL measure. The study group consisted of 211 children and adolescents with chronic kidney disease (CKD) (139 TR and 72 DP aged between 4-18 years; 13.7 +/- 3.5 years) from 11 university hospitals, 129 parents of these patients, 232 age-matched healthy children and adolescents (aged between 4-18 years; 13.1+/-3.5 years) and 156 of their parents. Patients with CKD had lower scores in all subscales except for physical well-being than those in the control group. TR had higher scores in physical well-being, self-esteem, friends' subscales, and total scores than DP. Child-self scores were lower than parent-proxy scores, especially in CKD, DP, and control groups. Concordance between parent-proxy and child-self reports in the TR, DP, CKD, and control groups was only moderate for the majority of subscales (r = 0.41-0.61). It was concluded that parent-proxy scores on the QoL were not equivalent to child-self scores and that evaluating both children's and parents' perspectives were important. Additionally, psychosocial counseling is crucial not only for patients with CKD but also for their parents.
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Abe T, Ichimaru N, Kakuta Y, Okumi M, Imamura R, Isaka Y, Takahara S, Kokado Y, Okuyama A. Long-term outcome of pediatric renal transplantation: a single center experience. Clin Transplant 2010; 25:388-94. [DOI: 10.1111/j.1399-0012.2010.01250.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Approach to optimizing growth, rehabilitation, and neurodevelopmental outcomes in children after solid-organ transplantation. Pediatr Clin North Am 2010; 57:539-57, table of contents. [PMID: 20371051 DOI: 10.1016/j.pcl.2010.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One of the most critical differences between the posttransplant care of children and adults is the requirement in children to maintain a state of health that supports normal physical and psychological growth and development. Most children with organ failure have some degree of growth failure and developmental delay, which is not quickly reversed after successful transplantation. The challenge for clinicians caring for these children is to use strategies that minimize these deficits before transplantation and provide maximal opportunity for recovery of normal developmental processes during posttransplant rehabilitation. The effect of chronic organ failure, frequently complicated by malnutrition, on growth potential and cognitive development is poorly understood. This review presents a summary of what is known regarding risk factors for suboptimal growth and development following solid-organ transplant and describe possible strategies to improve these outcomes.
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115
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Anthony SJ, Hebert D, Todd L, Korus M, Langlois V, Pool R, Robinson LA, Williams A, Pollock-BarZiv SM. Child and parental perspectives of multidimensional quality of life outcomes after kidney transplantation. Pediatr Transplant 2010; 14:249-56. [PMID: 19686446 DOI: 10.1111/j.1399-3046.2009.01214.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Kidney transplantation is an optimal therapy for pediatric patients with end-stage kidney disease. This pilot study sought to examine multidimensional QOL outcomes after kidney transplant using VAQOL and General Health, the PedsQL 4.0, PedsQL End Stage Renal Disease Module, and Impact on Family Module. Sample included 12 adolescents aged 13-18 yr and their parent; three children aged eight to 12 yr and their parent; and six parents of children aged two to seven yr. All were 73 months post transplant. The median age at transplant was 9.3 yr and median time since transplant was 3.2 yr. VAQOL mean was 7.7/10 (child report) and 7.3/10 (parent report); the mean general health was 7.4/10. High levels of fatigue (> or =5/10) were reported in 43%. PedsQL subscale mean values were lower than healthy reference scores. PedsQL Renal Module demonstrated great concern with physical appearance and physical symptoms (thirst and headaches), difficulty with peer and family interaction, and school disruption. Low scores on parental emotional function depict the negative impact of transplant on family functioning. Discordance exists between child and parental reports of QOL. Prospective studies are needed to explore multidimensional QOL to improve long-term outcomes after pediatric kidney transplant.
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Affiliation(s)
- Samantha J Anthony
- SickKids Transplant Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Gerson AC, Wentz A, Abraham AG, Mendley SR, Hooper SR, Butler RW, Gipson DS, Lande MB, Shinnar S, Moxey-Mims MM, Warady BA, Furth SL. Health-related quality of life of children with mild to moderate chronic kidney disease. Pediatrics 2010; 125:e349-57. [PMID: 20083528 PMCID: PMC3663134 DOI: 10.1542/peds.2009-0085] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the health-related quality of life (HRQoL) of children with chronic kidney disease (CKD) with healthy children; to evaluate the association between CKD severity and HRQoL; and to identity demographic, socioeconomic, and health-status variables that are associated with impairment in HRQoL in children with mild to moderate CKD. METHODS This was a cross-sectional assessment of HRQoL in children who were aged 2 to 16 and had mild to moderate CKD using the Pediatric Inventory of Quality of Life Core Scales (PedsQL). Overall HRQoL and PedsQL domain means for parents and youth were compared with previously published norms by using independent sample t tests. Study participants were categorized by kidney disease stage (measured by iohexol-based glomerular filtration rate [iGFR]), and group differences in HRQoL were evaluated by using analysis of variance and Cuzick trend tests. The association between hypothesized predictors of HRQoL and PedsQL scores was evaluated with linear and logistic regression analyses. RESULTS The study sample comprised 402 participants (mean age: 11 years, 60% male, 70% white, median iGFR: 42.5 mL/min per 1.73 m(2), median CKD duration: 7 years). Youth with CKD had significantly lower physical, school, emotional, and social domain scores than healthy youth. iGFR was not associated with HRQoL. Longer disease duration and older age were associated with higher PedsQL scores in the domains of physical, emotional, and social functioning. Older age was associated with lower school domain scores. Maternal education > or =16 years was associated with higher PedsQL scores in the domains of physical, school, and social functioning. Short stature was associated with lower scores in the physical functioning domain. CONCLUSIONS Children with mild to moderate CKD, in comparison with healthy children, reported poorer overall HRQoL and poorer physical, school, emotional, and social functioning. Early intervention to improve linear growth and to address school functioning difficulties is recommended.
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Affiliation(s)
- Arlene C Gerson
- Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, 200 N Wolfe St, #3060, Baltimore, MD 21287, USA.
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Abstract
Medical advances have allowed the majority of children with ESRD to survive into adulthood. As a result, more attention is being focused on improving the health-related quality of life (HRQOL) for children with ESRD. However, most pediatric ESRD HRQOL studies have highlighted on the psychosocial effects of ESRD, with less attention paid to the physical effects. A few studies have recently measured exercise capacity in children with ESRD in the last 5 years. This article reviews studies that detail the physical components of HRQOL as well as other studies that have started to document the exercise capacity of children with ESRD.
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118
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Hamiwka LA, Cantell M, Crawford S, Clark CG. Physical activity and health related quality of life in children following kidney transplantation. Pediatr Transplant 2009; 13:861-7. [PMID: 19497018 DOI: 10.1111/j.1399-3046.2009.01195.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Participation in PA is often diminished in children with CKD. Limited research exists on exercise tolerance/capacity but no studies to date have investigated lifestyle PA and its determinants in these children. The aim of this study was to investigate level of PA and potential physiological and psychological associations in a group of pediatric KTx recipients compared with CS. Twenty KTx and 33 CS participated. PA was measured by PAQ. HRQOL (PedsQL 4.0) and CY-PSPP were also measured. BMI and WC was recorded in all subjects; GFR, BP and immunosuppressants in KTx. Body measurements indicated the two groups were similar: 25% KTx and 24% CS had BMI >85th percentile. KTx were less physically active than CS in total exercise minutes (p = 0.005). CS reported higher HRQOL than KTx (p = 0.001). Higher perceptions of HRQOL were significantly correlated with higher number of steps/day in both groups (p = 0.034). KTx showed significantly lower perceptions of sports competence (p = 0.007) and physical conditioning (p = 0.001) than CS. Higher PAQ activity scores were significantly correlated with higher perceptions of body attractiveness (p = 0.019), Sport (p = 0.003) and Conditioning (p = 0.001). These results suggest that PA may play a role in overall well-being and HRQOL in KTx.
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Affiliation(s)
- Lorraine A Hamiwka
- Division of Pediatric Nephrology, Department of Pediatrics & Institute of Child and Maternal Health, Alberta Children's Hospital, University of Calgary, Calgary, Alberta Canada.
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Dodson JL, Cohn SE, Cox C, Hmiel PS, Wood E, Mattoo TK, Warady BA, Furth SL. Urinary incontinence in the CKiD cohort and health related quality of life. J Urol 2009; 182:2007-14. [PMID: 19695588 DOI: 10.1016/j.juro.2009.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Many children with chronic kidney disease have urinary incontinence due to urological disorders and/or a urine concentrating defect. We determined the prevalence and impact of incontinence on health related quality of life in children with chronic kidney disease. MATERIALS AND METHODS The Chronic Kidney Disease in Children study is a prospective, observational cohort of children recruited from 47 sites in the United States and Canada. Eligibility requirements are age 1 to 16 years and an estimated glomerular filtration rate of 30 to 90 ml per minute per 1.73 m(2). Demographics, continence status, glomerular filtration rate and physical examination were assessed at study entry. Health related quality of life was measured using the parent and child versions of PedsQL. PedsQL scores in participants 5 years old or older were compared among children who were toilet trained and not bed-wetting, bed-wetting or not toilet trained using multivariate linear regression. RESULTS Overall median age of the 329 participants was 12.5 years, 61.4% were male, 70% were white and 55.5% had a urological disorder. Of participants 71.4% were toilet trained at study enrollment, 23.1% had bed-wetting and 5.5% were not toilet trained. Children who were not yet toilet trained had an average total score that was 13.5 points lower (95% CI -25.2, -1.8) on the PedsQL child report than in those who were toilet trained (p = 0.02). Physical functioning (-15.0, 95% CI -28.2, -1.9) and school functioning (-15.3, 95% CI -29.8, -0.8) were also lower in this group (p = 0.03 and 0.04, respectively). On the PedsQL parent proxy report physical functioning (-14.2, 95% CI -26.7, -1.6) was similarly affected by child incontinence (p = 0.03). CONCLUSIONS Urinary incontinence is common in pediatric patients with chronic kidney disease and associated with lower health related quality of life on the PedsQL child and parent proxy reports. Early recognition of and treatment for urinary incontinence may improve health related quality of life in this population.
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Affiliation(s)
- Jennifer L Dodson
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2101, USA.
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121
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Goldstein SL, Rosburg NM, Warady BA, Seikaly M, McDonald R, Limbers C, Varni JW. Pediatric end stage renal disease health-related quality of life differs by modality: a PedsQL ESRD analysis. Pediatr Nephrol 2009; 24:1553-60. [PMID: 19421787 DOI: 10.1007/s00467-009-1174-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/02/2009] [Accepted: 02/19/2009] [Indexed: 10/20/2022]
Abstract
We previously validated the 34-item PedsQL 3.0 End Stage Renal Disease (ESRD) Module designed to measure pediatric ESRD-specific health-related quality of life (HRQOL) in children and adolescents receiving maintenance dialysis or with a renal transplant. The study reported here was undertaken to assess for potential HRQOL differences between ESRD modality in children with ESRD and their parents using the PedsQL 3.0 ESRD Module. Parents of patients with a renal transplant reported a significantly higher HRQOL for their children than parents of pediatric patients receiving dialysis on all ESRD Module Scales except the Perceived Physical Appearance Scale, with the majority of the effect sizes in the medium range. Pediatric renal transplant patients self-reported comparable HRQOL to pediatric patients receiving dialysis across the ESRD Module Scales, with the exception of the Family and Peer Interaction Scale, in which pediatric renal transplant patients self-reported significantly higher HRQOL than pediatric patients receiving dialysis. Our cross-sectional data suggest that parents of children with ESRD observe a positive impact from renal transplantation on the majority of HRQOL domains compared to dialysis, whereas children self-report generally non-significant small effect size differences in favor of renal transplantation. These findings suggest that the PedsQL ESRD 3.0 Module may be used to identify ESRD- and modality-specific challenges that impact pediatric patient HRQOL.
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Affiliation(s)
- Stuart L Goldstein
- Texas Children's Hospital, Baylor College of Medicine, 52 6621 Fannin Street, MC 3-2482, Houston, TX 77030, USA.
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Quality of life of adolescents with end-stage renal disease and kidney transplant. Pediatr Nephrol 2009; 24:1561-8. [PMID: 19475433 DOI: 10.1007/s00467-009-1175-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 02/18/2009] [Accepted: 03/06/2009] [Indexed: 10/20/2022]
Abstract
The health-related quality of life (HRQOL) of adolescents with end-stage renal disease (ESRD) is an important marker of disease burden. Our aims were to investigate HRQOL in a group of children and adolescents with ESRD and to compare them with the reference population norms. Ours was a cross-sectional study of 81 patients aged 10 years to 21 years with ESRD (68 with kidney transplants and 13 on dialysis) at five Spanish paediatric nephrology centres. HRQOL was investigated with the Spanish version of the child health and illness profile, adolescent edition (CHIP-AE). Clinical variables such as underlying diagnosis, number of rejection episodes, pre-emptive transplantation, anaemia and height were also analysed. No differences were found between patients with kidney transplants and their healthy peers in any domain or sub-domain of CHIP-AE. The group on dialysis scored lower than healthy controls and patients with transplants for satisfaction with health. Discomfort was higher in patients with transplants who had suffered one rejection episode. Physical discomfort was increased in anaemic patients with transplants. Short patients scored less in the satisfaction domain, with lower self-esteem and lower satisfaction with health. Adolescents with kidney transplants had better satisfaction with health than the group on dialysis, which matched the level of a healthy population. Further long-term prospective research is warranted.
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124
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A pilot study of twice-weekly exercise during hemodialysis in children. Pediatr Nephrol 2009; 24:833-9. [PMID: 19093138 DOI: 10.1007/s00467-008-1079-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
Abstract
Few published studies have assessed the exercise capacity and/or the effect of exercise in children receiving maintenance hemodialysis (HD). The aim of this study was to determine if twice-weekly exercise for 1 h during HD could improve exercise capacity in children receiving HD. We assessed lower extremity strength (Biodex; dominant extension peak torque in 60 degrees per second, Newton-meters), grip strength (dynanometer, kilogram) and 6-min walk capacity (yards) in ten children (median age 13.6 years, range 8-25 years) at baseline and after 3 months of twice weekly exercise for 1 h during HD. Baseline assessment revealed a mean (1) Biodex of 70 +/- 32 N-m/s, (2) 6-m walk test of 589 +/- 90 yards and (3) grip strength of 23.2 +/- 10 kg, which were 50% lower than the normal value for healthy controls. Patients demonstrated significant improvements in lower extremity strength and 6-min walk test after 3 months of exercise. Our data show that twice-weekly exercise of a moderate intensity during HD can lead to exercise capacity improvement in 3 months. We identified barriers to and strategies for the successful implementation of intradialytic exercise. We suggest that intradialytic exercise intervention may be effective to improve exercise capacity in children receiving maintenance HD.
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125
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Lai WM. Quality of Life in Children with End-Stage Renal Disease: Does Treatment Modality Matter? Perit Dial Int 2009. [DOI: 10.1177/089686080902902s38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In children with end-stage renal disease (ESRD), health-related quality of life (HRQOL) is a useful and important clinical measure for monitoring the child's well-being and functional status. One of the commonly used generic HRQOL instruments in children is the Pediatric Quality of Life Inventory, because an ESRD-specific instrument for children is still lacking. In the limited studies of HRQOL in children with ESRD, a significant effect of ESRD is seen, with significantly lower HRQOL scores than are seen in healthy children. In future, a pediatric ESRD-specific instrument is needed to address differences in HRQOL between children on hemodialysis, on peritoneal dialysis, and with a kidney graft.
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Affiliation(s)
- Wai-Ming Lai
- Paediatric Nephrology Center, Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
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126
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Shroff R, Ledermann S. Long-term outcome of chronic dialysis in children. Pediatr Nephrol 2009; 24:463-74. [PMID: 18214549 PMCID: PMC2755764 DOI: 10.1007/s00467-007-0700-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 10/02/2007] [Accepted: 10/23/2007] [Indexed: 12/22/2022]
Abstract
As the prevalence of children on renal replacement therapy (RRT) increases world wide and such therapy comprises at least 2% of any national dialysis or transplant programme, it is essential that paediatric nephrologists are able to advise families on the possible outcome for their child on dialysis. Most children start dialysis with the expectation that successful renal transplantation is an achievable goal and will provide the best survival and quality of life. However, some will require long-term dialysis or may return intermittently to dialysis during the course of their chronic kidney disease (CKD). This article reviews the available outcome data for children on chronic dialysis as well as extrapolating data from the larger adult dialysis experience to inform our paediatric practice. The multiple factors that may influence outcome, and, particularly, those that can potentially be modified, are discussed.
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Affiliation(s)
- Rukshana Shroff
- Department of Nephrourology, Great Ormond Street Hospital for Children NHS Trust London, Great Ormond Street, London, WC1 N3JH UK
| | - Sarah Ledermann
- Department of Nephrourology, Great Ormond Street Hospital for Children NHS Trust London, Great Ormond Street, London, WC1 N3JH UK
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Kim SD, Cho BS. Current status of pediatric kidney transplantation. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.10.1075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sung-Do Kim
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Byoung-Soo Cho
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, Korea
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Shenoy M, Pararajasingam R, Wright NB, Lewis MA, Parrott N, Riad H, Webb NJA. Successful renal transplantation in children in the presence of thrombosis of the inferior vena cava. Pediatr Nephrol 2008; 23:2261-5. [PMID: 18253760 DOI: 10.1007/s00467-007-0736-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 11/27/2007] [Accepted: 11/29/2007] [Indexed: 11/27/2022]
Abstract
Thrombosis of the inferior vena cava (IVC) has previously been considered to be a contraindication to renal transplantation in children because of the technical difficulties associated with surgery and the increased risk of graft thrombosis. We report three children with previous IVC thrombosis who underwent renal transplantation at our institution over the last 5 years. The pretransplant imaging of these patients included direct venography or magnetic resonance venography to evaluate venous outflow. Two children (19 kg and 36 kg) received deceased donor renal allografts with no surgical complications or delayed graft function. At the latest follow-up 3.0 and 4.6 years posttransplantation, respectively, they were well, with estimated glomerular filtration rates of 52 and 64 ml/min per 1.73 m(2), respectively. The third child underwent a live-related-donor renal transplant at the age of 4.9 years (weight 13.5 kg). There was primary graft nonfunction. Renal vein thrombosis was noted on postoperative day 12, with subsequent graft loss. Children with previous IVC thrombosis can be successfully transplanted with adult-sized kidneys provided detailed evaluation of the venous drainage has been performed. There is substantial risk of graft thrombosis, and detailed counselling regarding the specific risks of the procedure is essential.
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Affiliation(s)
- Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, M27 4HA, UK
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Zaritsky JJ, Salusky IB, Gales B, Ramos G, Atkinson J, Allsteadt A, Brandt ML, Goldstein SL. Vascular access complications in long-term pediatric hemodialysis patients. Pediatr Nephrol 2008; 23:2061-5. [PMID: 18712416 DOI: 10.1007/s00467-008-0956-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 06/09/2008] [Accepted: 07/01/2008] [Indexed: 11/30/2022]
Abstract
Current data demonstrate pediatric patients who remain on hemodialysis (HD) therapy are more likely to be dialyzed via central venous catheters (CVCs) than arteriovenous grafts (AVGs) and fistulae (AVFs). We retrospectively compared complications and health-related quality of life (HRQOL) associated with different vascular access types at two large centers over a 1-year period. Patients included in the study were younger than 25 years of age, weighed >20 kg, and had received HD for at least 3 months. Thirty CVC patients and 21 AVG/AVF patients received a total of 2,393 and 3,506 HD treatments, respectively. The infectious complication rate was higher for CVC patients, who were hospitalized 3.7 days for each 100 HD treatments versus 0.2 days for AVG/AVF patients (p < 0.01). CVC patients also had a much higher rate of access revision, needing 2.7 hospital days every 100 HD treatments compared with 0.2 days for AVG/AVF patients (p < 0.01). HRQOL scores did not differ between groups. Thus, despite similar HRQOL, CVCs were associated with more complications and greater morbidity when compared with AVG/AVFs. These findings further emphasize the need to use AVG/AVFs as primary HD access for pediatric patients expected to receive a long course of maintenance HD.
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Affiliation(s)
- Joshua J Zaritsky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Abstract
PURPOSE OF REVIEW The pediatric patient with end-stage renal disease provides a great opportunity for the involvement of the pediatric urologist because of the high incidence of associated urologic anomalies. RECENT FINDINGS Renal transplant remains the procedure of choice in the child with end-stage renal disease. The durability of survival of the graft is impacted by successful management of the genitourinary tract. SUMMARY Preoperative, intraoperative, and postoperative evaluation is critical for the child with associated urologic disease and end-stage renal disease. Early and appropriate management may stabilize renal function and prolong the time to transplant. Due to the relatively long life expectancy of children compared with adults with end-stage renal disease, appropriate management may be of benefit to avoid the morbidity associated with renal replacement therapy. In certain children, the appropriate management and reconstruction of the genitourinary tract may allow for a planned and preemptive renal transplant, thus avoiding dialysis.
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132
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Parent perspectives of health related quality of life in adolescents with chronic kidney disease due to underlying urological disorders: an assessment using the Child Health Questionnaire-Parent Form 50. J Urol 2008; 180:1700-4; discussion 1704. [PMID: 18718618 DOI: 10.1016/j.juro.2008.03.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE Little is known about health related quality of life in adolescents with chronic kidney disease due to urological anomalies. We assessed generic health related quality of life in this population using a validated parent proxy instrument. MATERIALS AND METHODS In this multicenter prospective cohort study the Child Health Questionnaire-Parent Form 50, a generic health related quality of life parent proxy instrument, was administered to 92 parents of adolescents 10 to 18 years old with chronic kidney disease. Mean summary measure and scale scores in adolescents with urological anomalies were compared to scores in those with other causes of kidney disease and in a representative American population sample. RESULTS The cohort included 35 adolescents with an underlying diagnosis of congenital urological anomaly and 57 with another cause of kidney disease. There were no significant differences in mean scale or summary measure scores between the 2 diagnostic groups. When compared to a representative population sample, adolescents with congenital urological anomalies scored significantly worse on the questionnaire physical summary measure (44.5, 95% CI 39.9-49.1 vs 52.0, 95% CI 51.1-52.9, p = 0.002), and on the Child Health Questionnaire scales physical functioning, role physical, general health perceptions, family activities and parental emotional impact. CONCLUSIONS As assessed by Child Health Questionnaire-Parent Form 50, parents reported that adolescents with chronic kidney disease due to urological disorders scored lower on the physical summary measure than a population based reference sample and they reported a negative effect on family activities and parental emotional well-being. These findings suggest that the Child Health Questionnaire-Parent Form 50 could provide a family based assessment of generic health related quality of life in adolescents with urological disorders.
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133
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Outcome after renal transplantation. Part II: quality of life and psychosocial adjustment. Pediatr Nephrol 2008; 23:1347-54. [PMID: 18386069 DOI: 10.1007/s00467-008-0798-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 02/08/2008] [Accepted: 02/08/2008] [Indexed: 10/22/2022]
Abstract
Knowledge of health-related quality of life (QOL) and psychosocial adjustment (PA) in children after renal transplantation (RTPL) is limited. QOL and PA were evaluated by standardized tests in patients after RTPL. Thirty-seven children of median age 14.5 years (range 6.5-17 years) were investigated a mean 4.5 years (range 0.5-12.8 years) after RTPL. Child- and parent-rated QOL was evaluated with the Child Quality of life Questionnaire of The Netherlands Organization for Applied Scientific Research Academical Medical Centre (TNO-AZL). PA was assessed by the Child Behaviour Checklist (CBCL) providing parental reports of a child's behaviour. In patients' self-ratings, the QOL dimension physical complaints (P < 0.0005) scored significantly better than that of healthy controls, whereas the dimension positive emotional functioning was impaired (P = 0.02). Parents rated motor functioning (P = 0.002), autonomy (P = 0.01), cognition (P = 0.04) and positive emotions (P < 0.0005) as significantly impaired. Parents also assessed PA significantly (P = 0.02) impaired with regard to internalizing behaviour. Dialysis duration, young age at RTPL, living-related donation, steroid treatment, adverse family relationships and maternal distress had a significantly negative impact on QOL and PA (P < 0.05). Patients rated QOL higher than did healthy controls. Parents evaluated their children's QOL and PA more pessimistically than did the patients themselves. Both illness-related variables and family environment played an important role.
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134
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An Empirical Investigation of Physicians’ Attitudes Toward Intrasibling Kidney Donation by Minor Twins. Transplantation 2008; 85:1235-9. [DOI: 10.1097/01.tp.0000312675.51853.52] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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135
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Palta M, Sadek-Badawi M. PedsQL relates to function and behavior in very low and normal birth weight 2- and 3-year-olds from a regional cohort. Qual Life Res 2008; 17:691-700. [PMID: 18459069 DOI: 10.1007/s11136-008-9346-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 04/04/2008] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To compare PedsQL scores in young children who were very low (< or =1,500 g) or normal birth weight (>2,500 g) and to examine the relationship of the PedsQL score to behavioral and functional scores. METHODS The PedsQL, Achenbach Child Behavior Checklist and the PEDI functional scales were telephone administered to parents of a regional cohort of 672 very low birth weight and 455 normal birth weight children, 2- and 3-years old. PedsQL scales were regressed on behavior, function and health conditions. RESULTS Mean (SD) overall PedsQL score was 91 (8.4) for normal birth weight and 87 (12) for very low birth weight children, and changed little when standardized to the race/ethnicity and maternal education of corresponding Wisconsin births. Mobility function and the CBCL explained 58% of the variance in PedsQL, but the relationship was curvilinear. CONCLUSION The PedsQL is sensitive to health problems of very low birth weight in young children. The PedsQL is quite strongly related to mobility and behavior problems, but scales these differently than do standard instruments. Parents either do not think of subtle issues with child function and behavior without specific prompting or do not perceive them as problems affecting quality of life.
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Affiliation(s)
- Mari Palta
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA.
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Mills JLA, Konkin DE, Milner R, Penner JG, Langer M, Webber EM. Long-term bowel function and quality of life in children with Hirschsprung's disease. J Pediatr Surg 2008; 43:899-905. [PMID: 18485963 DOI: 10.1016/j.jpedsurg.2007.12.038] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 12/03/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE Little is known about the quality of life (QOL) of children with Hirschsprung's disease (HD) as they grow older. The purpose of this study was to measure the QOL and bowel function of these children as they mature. METHODS All children who were surgically treated for HD at British Columbia Children's Hospital, Vancouver, British Columbia, Canada between 1986 and 2003 were invited to participate. Each family was sent 3 previously validated questionnaires exploring current QOL and bowel function. RESULTS Fifty-one families participated (49%), with children between the ages of 3 and 21 years. Fecal continence improved significantly with age (P = .04) and was the strongest predictor of QOL scores of all variables in our study. There was no statistically significant difference in QOL scores between children with HD and healthy children, although a clinically relevant impairment in QOL may be present, especially in psychosocial scores. CONCLUSIONS Fecal continence is an important predictor of overall QOL in children surgically treated for HD. Although continence tends to improve with age, a number of older children still have ongoing continence problems, and they seem to be a group at risk for impaired QOL. Our study indicates that interventions for children with incontinence may offer gains in QOL as well as bowel function.
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Affiliation(s)
- Jessica L A Mills
- Division of Pediatric General Surgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada V6M 2L8
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Goldstein SL, Graham N, Warady BA, Seikaly M, McDonald R, Burwinkle TM, Limbers CA, Varni JW. Measuring health-related quality of life in children with ESRD: performance of the generic and ESRD-specific instrument of the Pediatric Quality of Life Inventory (PedsQL). Am J Kidney Dis 2008; 51:285-97. [PMID: 18215706 DOI: 10.1053/j.ajkd.2007.09.021] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 09/24/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND Minimal data exist to describe health-related quality of life in children with end-stage renal disease (ESRD). STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS 193 children aged 5 to 18 years with ESRD and 190 parents of children aged 2 to 18 years with ESRD at 4 pediatric nephrology centers across the United States. OUTCOMES & MEASUREMENTS Generic and disease-specific health-related quality of life. The Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) Generic Core Scales encompass: (1) Physical Functioning (8 items), (2) Emotional Functioning (5 items), (3) Social Functioning (5 items), and (4) School Functioning (5 items). The PedsQL 3.0 ESRD Module encompasses: (1) General Fatigue (4 items), (2) About My Kidney Disease (5 items), (3) Treatment Problems (4 items), (4) Family and Peer Interaction (3 items), (5) Worry (10 items), (6) Perceived Physical Appearance (3 items), and (7) Communication (5 items). RESULTS Internal consistency reliability for the PedsQL 4.0 Generic Core Scales and the PedsQL 3.0 ESRD Module was acceptable for both parent-proxy report and child self-report, with the exception of 1 parent-proxy report and 3 child self-report scales on the ESRD Module. The PedsQL Generic Core Scales differentiated between healthy children and children with ESRD, supporting discriminant validity. Intercorrelations between the PedsQL Generic Core Scales and the ESRD Module were in the medium to large range, supporting construct validity. A confirmatory factor analysis further supported construct validity of the ESRD Module. LIMITATIONS Test-retest reliability was not conducted, limited generalizability may exist given the age distribution of the children included, and imperfect agreement between child and parent-proxy reports. CONCLUSIONS Results support the feasibility, reliability, and validity of the PedsQL 4.0 Generic Core Scales in children with ESRD and provide initial support for the PedsQL 3.0 ESRD Module, although additional validation testing is warranted.
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Rudnick EF, Mitchell RB. Long-term improvements in quality-of-life after surgical therapy for pediatric sinonasal disease. Otolaryngol Head Neck Surg 2008; 137:873-7. [PMID: 18036413 DOI: 10.1016/j.otohns.2007.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 07/08/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study long-term changes in quality-of-life (QOL) in children after surgery for chronic sinonasal disease. DESIGN Prospective, nonrandomized. METHODS Caregivers completed the SN-5 QOL instrument before surgery. Children underwent either adenoidectomy or endoscopic sinus surgery (ESS). Caregivers then completed a survey <6 months (short-term) and between six and 24 months after surgery (long-term). Scores were compared using a paired t test. RESULTS Twenty-two children were enrolled (mean age, 5.7 years). The majority (59%) of children underwent ESS. The mean preoperative total score was 25.6. Postoperatively, the mean total score was 11.7 at short-term (P < 0.0001) and 11.5 at long-term follow-up (P < 0.0001). Short- and long-term postoperative scores for all domains were significantly different from preoperative scores. In the long-term scores, the domain with the greatest change was "emotional distress" (SRM 1.9) and with the smallest change was "allergy symptoms" (SRM 1.0). There were no significant differences between children who underwent adenoidectomy compared with ESS. CONCLUSIONS After adenoidectomy or ESS, caregivers observe a long-term improvement in QOL of children with sinonasal disease.
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Affiliation(s)
- Emily F Rudnick
- Division of Pediatric Otolaryngology, Department of Otolaryngology Head and Neck Surgery, Children's Hospital and Regional Medical Center, The University of Washington School of Medicine, Seattle, WA 98105, USA.
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Frequent hemodialysis with NxStage system in pediatric patients receiving maintenance hemodialysis. Pediatr Nephrol 2008; 23:129-35. [PMID: 17990005 DOI: 10.1007/s00467-007-0649-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 08/23/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
Abstract
Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38-61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate <1 g/kg per day at the beginning of the study improved to a normalized protein catabolic rate (nPCR) of >1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage system be considered for children who would benefit from home-based maintenance dialysis.
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140
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Simon AE, Chan KS, Forrest CB. Assessment of children's health-related quality of life in the United States with a multidimensional index. Pediatrics 2008; 121:e118-26. [PMID: 18056290 DOI: 10.1542/peds.2007-0480] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Using nationally representative data, we examined biological, medical system, and sociodemographic factors that are associated with health-related quality of life as measured by a multidimensional index that accounts for a wide range of child health domains. METHODS Children aged > or = 6 years (N = 69,031) were drawn from the 2003/2004 National Survey of Children's Health. A random 25% sample was used to create a 12-item index of health-related quality of life with a range of 0 to 100, based on the conceptual framework of the Child Health and Illness Profile. Bivariate and multivariable regression analyses were conducted to identify the unadjusted and independent associations of key biological, medical system, and sociodemographic variables with health-related quality of life. RESULTS The index mean was 72.3 (SD: 14.5), median value was 73.7, and range was 11.1 to 99.9. Only 0.2% of children had a score at the ceiling. In multivariable regression analysis, the following variables were independently associated with lower health-related quality of life: biological factors (greater disease burden, severe asthma, and overweight status); medical system factors (unmet medical needs, lack of a regular health care provider, Medicaid insurance, or being uninsured previously during the year); and sociodemographic factors (older age groups, lower family education, single-mother family, having a smoker in the household, black race, and poverty). CONCLUSIONS Health-related quality of life in the United States is poorest for children and youth in lower socioeconomic status groups, those with access barriers, adolescents compared with children, and individuals with medical conditions. A multidimensional health-related quality-of-life index is an alternative to conventional measures (eg, mortality) for national monitoring of child health.
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141
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Giessing M, Muller D, Winkelmann B, Roigas J, Loening SA. Kidney transplantation in children and adolescents. Transplant Proc 2007; 39:2197-201. [PMID: 17889136 DOI: 10.1016/j.transproceed.2007.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Worldwide, specific pediatric allocation schemes successfully try to minimize waiting time for children with end-stage renal disease (ESRD). The article is a review of current issues in pediatric kidney transplantation. The procedure is the treatment of choice for children and adolescents with ESRD, with 1- and 3-year graft survival rates of 95% and 90% and recipient survival after 5 and 10 years of 95% and 90%. Preoperative surgery is often necessary to minimize negative effects of congenital anomalies. No minimum age exists for pediatric transplantation, but most often the recipient body weight is ideally above 10 to 15 kg. Technical concepts should include extravesical anastomosis, stenting of the ureter, and potentially intraperitoneal placement of the graft. Immunosuppression has constantly improved. The aim is a tailored regimen to reduce side effects and improve compliance, which necessitates intense counseling of the child and the parents prior to, during, and after transplantation as many adolescents lose their graft due to noncompliance. Intense follow-up must also exclude infections, especially with herpes and polyoma viruses. For the future, age matching may be only one promising concept to improve results. As only a small number of children require the procedure in each country, multinational studies should be initiated to optimize outcomes in children and adolescents.
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Affiliation(s)
- M Giessing
- Charité University Hospital, Department of Urology (Campus Mitte), Berlin, Germany.
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142
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Goldstein SL, Gerson AC, Furth S. Health-related quality of life for children with chronic kidney disease. Adv Chronic Kidney Dis 2007; 14:364-9. [PMID: 17904504 DOI: 10.1053/j.ackd.2007.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical care advancements for children with chronic kidney disease (CKD) receiving hemodialysis, peritoneal dialysis, or with a kidney transplant have resulted in relatively improved long-term patient survival compared with adult patients with CKD. Optimal care for the pediatric patient with CKD requires attention not only to medical management but also the psychosocial and developmental factors that will either ensure or prevent a pediatric patient's successful transition into adulthood. We review the range of issues that impact pediatric CKD patient health-related quality of life (HRQOL), the history of pediatric CKD patient HRQOL investigation, and the instruments currently available to assess HRQOL.
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Affiliation(s)
- Stuart L Goldstein
- Renal Dialysis Unit Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA.
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143
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Dodson JL, Diener-West M, Gerson AC, Kaskel FJ, Furth SL. An Assessment of Health Related Quality of Life Using the Child Health and Illness Profile-Adolescent Edition in Adolescents With Chronic Kidney Disease Due to Underlying Urological Disorders. J Urol 2007; 178:660-5; discussion 665. [PMID: 17574620 DOI: 10.1016/j.juro.2007.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We examined health related quality of life in adolescents with congenital urological disease causing kidney disease using a generic health related quality of life instrument. We then compared the results to those in adolescents with medical kidney disease and to population based norms. MATERIALS AND METHODS The Child Health and Illness Profile-Adolescent Edition was administered to 113 patients 10 to 18 years old with chronic kidney disease. Mean domain and subdomain scores for adolescents with urological disease were compared to those of adolescents with medical kidney disease and to population based norms. RESULTS The cohort included adolescents with an underlying diagnosis of congenital urological anomaly (37 patients) or other causes of kidney disease (76). Compared to adolescents with kidney disease caused by other factors, those with congenital urological disease scored statistically significantly better in the Child Health and Illness Profile-Adolescent Edition subdomain of Limitations of Activity (mean 22.3 [SD 2.5] vs 20.4 [SD 5.0], p = 0.04). Compared to population norms, adolescents with congenital disorders scored lower in the Disorders domain (mean 16.5, 95% CI 14.2 to 18.9) but better in the Risks domain (mean 25.9, 95% CI 25.1 to 26.6) and in the Home Safety and Health subdomain (mean 25.2, 95% CI 23.7 to 26.6). CONCLUSIONS As assessed by the Child Health and Illness Profile-Adolescent Edition generic health status questionnaire, adolescents with kidney disease due to underlying congenital urological disease had fewer limitations of activity compared to those with underlying medical kidney disease. Except for low scores in the Disorders domain, children with underlying urological disease did not have significant impairments in any other domain compared to population based norms.
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Affiliation(s)
- Jennifer L Dodson
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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144
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Abstract
While renal transplantation remains the most prevalent treatment for children with end-stage renal disease, the majority of children incident to ESRD receive dialytic therapy prior to receiving a renal allograft and 25% of children are still receiving dialytic therapy 36 months after achieving ESRD. The current review discusses the most recent advancements in both hemodialysis and PD therapies to provide optimal care for children as a bridge until renal transplantation. Areas covered include dialysis dose assessment, target dry weight assessment, vascular access and advancements in PD technology.
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Affiliation(s)
- Stuart L Goldstein
- Baylor College of Medicine and Renal Dialysis Unit and Pheresis Service, 6621 Fannin Street, Texas Children's Hospital, Houston, TX 77030, USA.
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145
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Varni JW, Limbers CA, Burwinkle TM. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes 2007; 5:43. [PMID: 17634123 PMCID: PMC1964786 DOI: 10.1186/1477-7525-5-43] [Citation(s) in RCA: 575] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 07/16/2007] [Indexed: 11/23/2022] Open
Abstract
Background Advances in biomedical science and technology have resulted in dramatic improvements in the healthcare of pediatric chronic conditions. With enhanced survival, health-related quality of life (HRQOL) issues have become more salient. The objectives of this study were to compare generic HRQOL across ten chronic disease clusters and 33 disease categories/severities from the perspectives of patients and parents. Comparisons were also benchmarked with healthy children data. Methods The analyses were based on over 2,500 pediatric patients from 10 physician-diagnosed disease clusters and 33 disease categories/severities and over 9,500 healthy children utilizing the PedsQL™ 4.0 Generic Core Scales. Patients were recruited from general pediatric clinics, subspecialty clinics, and hospitals. Results Pediatric patients with diabetes, gastrointestinal conditions, cardiac conditions, asthma, obesity, end stage renal disease, psychiatric disorders, cancer, rheumatologic conditions, and cerebral palsy self-reported progressively more impaired overall HRQOL than healthy children, respectively, with medium to large effect sizes. Patients with cerebral palsy self-reported the most impaired HRQOL, while patients with diabetes self-reported the best HRQOL. Parent proxy-reports generally paralleled patient self-report, with several notable differences. Conclusion The results demonstrate differential effects of pediatric chronic conditions on patient HRQOL across diseases clusters, categories, and severities utilizing the PedsQL™ 4.0 Generic Core Scales from the perspectives of pediatric patients and parents. The data contained within this study represents a larger and more diverse population of pediatric patients with chronic conditions than previously reported in the extant literature. The findings contribute important information on the differential effects of pediatric chronic conditions on generic HRQOL from the perspectives of children and parents utilizing the PedsQL™ 4.0 Generic Core Scales. These findings with the PedsQL™ have clinical implications for the healthcare services provided for children with chronic health conditions. Given the degree of reported impairment based on PedsQL™ scores across different pediatric chronic conditions, the need for more efficacious targeted treatments for those pediatric patients with more severely impaired HRQOL is clearly and urgently indicated.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX 77843-3137, USA
| | - Christine A Limbers
- Department of Psychology, College of Liberal Arts, Texas A&M University, College Station, TX 77843-3137, USA
| | - Tasha M Burwinkle
- The Children's Hospital at Scott & White, Department of Pediatrics, College of Medicine, Texas A&M University Health Science Center, 2401 South 31st Street, Temple, TX 76508, USA
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Abstract
Frequent hemodialysis is currently conducted in a limited number of pediatric dialysis centers. However, the preliminary experience with children who have undergone procedures such as "daily" intensive hemodiafiltration and nocturnal hemodialysis has been positive, with the allowance for unrestricted diets and fluid intake, the lack of need for phosphate binders, excellent metabolic and blood pressure control, and, in the case of hemodiafiltration, excellent growth. The provision of frequent daily hemodialysis with the NxStage System has also recently been introduced to pediatrics. An overview about what is currently understood regarding the technical and clinical application of these approaches to therapy for children with end-stage renal disease form the basis for this article and highlight the impact of the procedures to date and the need for additional experience and collaborative data collection.
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147
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Ortega F, Valdés C, Ortega T. Quality of life after solid organ transplantation. Transplant Rev (Orlando) 2007. [DOI: 10.1016/j.trre.2007.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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148
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White CT, Trnka P, Matsell DG. Selected Primary Care Issues and Comorbidities in Children Who Are on Maintenance Dialysis: A Review for the Pediatric Nephrologist. Clin J Am Soc Nephrol 2007; 2:847-57. [PMID: 17699502 DOI: 10.2215/cjn.04021206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ten-year survival of all children who initiate dialysis at any age now approaches 70%, and in the older child this number is closer to 80%. These children will live with chronic kidney disease and its myriad of associated comorbidities during and throughout their childhood. Their care is complex and requires both teamwork and careful attention paid to maintaining lines of communication among patient, family, and both the facility-based nephrology team and caregivers who are outside the hospital setting. Irrespective of their need for dialysis, children with ESRD deserve and require developmentally appropriate care and anticipatory guidance with respect to primary care issues of childhood. The child who is on dialysis often is cared for solely or in large part by a nephrology service, therefore this review discusses issues that are particularly important to pediatric nephrologists in relation to selected primary care issues and comorbidities for the child who is on dialysis, with an emphasis on medical and psychosocial issues, and with particular weight placed on issues that are pertinent to the adolescent dialysis patient.
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Affiliation(s)
- Colin Thomas White
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.
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149
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Yildirim A, Ogutmen B, Bektas G, Isci E, Mete M, Tolgay HI. Translation, cultural adaptation, initial reliability, and validation of the Kidney Disease and Quality of Life-Short Form (KDQOL-SF 1.3) in Turkey. Transplant Proc 2007; 39:51-4. [PMID: 17275473 DOI: 10.1016/j.transproceed.2006.10.196] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Indexed: 11/18/2022]
Abstract
Health-related quality of life (HRQoL) is an important factor that can interfere with treatment outcomes. The aim of the present study was cultural adaptation, validation, and translation of the Kidney Disease Quality of Life-Short Form (KDQoL-SF 1.3) questionnaire into Turkish for the Turkish population. The KDQOL-SF was translated into Turkish and back-translated into English. Patient difficulties in understanding the questionnaire were evaluated and solved by a panel of experts. Measurement properties such as reliability and validity were determined by applying the questionnaire to 82 patients on dialysis, who were randomly selected from the dialysis units of 3 educational and research hospitals in Istanbul: 65% were females; mean patient age was 51 +/- 12 years. The most common primary causes of renal failure were glomerulonephritis (47%), hypertension (31%), and diabetes (7%). The median time on dialysis among the patients was 3 years. Test and retest methods were used for reliability. The total test-retest reliability Cronbach alpha coefficient of the Turkish KDQOL-SF questionnaire was 0.84 to 0.91. These coefficients were statistically significant (P < .05) for 19 dimensions of the KDQOL-SF that ranged from 0.75 to 0.91. The Cronbach alpha coefficient was higher than 0.80 for most components. To evaluate its construct validity, the KDQOL-SF was compared with the Turkish version of the 15D, an instrument for global assessment that contains 15 items divided into 5 dimensions. The scores range from 0 to 1 (0 = worse health status, 1 = better health status). Significant correlations were observed between the scores of the similar domains of the 15D and the KDQOL-SF. The best correlations were observed between physical functioning (KDQOL-SF) and mobility (15D; r = -.810) and between emotional well-being of (KDQOL-SF), and with the mental functions of 15D; (r = -.784), sexual function (KDQOL-SF) and sexual activity (15D; r = -.781), and patient satisfaction and distress (r = -.801). These findings support the construct validity of the new Turkish adapted KDQOL-SF. This study is reporting the complete process of translation and validation of the KDQOL-SF in the literature. These results demonstrate the high reliability and validity of this questionnaire for Turkish patients on dialysis.
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Affiliation(s)
- A Yildirim
- Marmara University Health Education Faculty, Kartal-Cevizli-Istanbul, Turkey
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150
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Abresch RT, McDonald DA, Widman LM, McGinnis K, Hickey KJ. Impact of spinal cord dysfunction and obesity on the health-related quality of life of children and adolescents. J Spinal Cord Med 2007; 30 Suppl 1:S112-8. [PMID: 17874696 PMCID: PMC2031984 DOI: 10.1080/10790268.2007.11754614] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 02/09/2007] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objectives of this study were: (1) to compare the health-related quality of life (HRQOL) of children and adolescents with mobility impairments due to spinal cord injury (SCI) and spina bifida (SB) to the HRQOL of children and adolescent controls without mobility impairments (CTRL); and (2) to examine the impact of of obesity on the HRQOL of these subjects. METHODS The Pediatric Quality of Life Inventory (PedsQL) was administered to 42 SB, 71 SCI and 60 able-bodied subjects who were 8-20 years of age. Subjects were categorized as obese if their BMI exceeded the 95th percentile for age. Twenty-one CTRL, 26 SB and 26 SCI subjects were obese. RESULTS The SCI and SB subjects had significantly lower subscores than the control subjects on the physical (p < 0.001), emotional (p < .01), social (p < .001), and school (p < .001) domains of the PedsQL. The obese (CTRL) group had lower subscores on the physical (p < 0.001), social (p < 0.001), and psychosocial (p < 0.001) domains of the PedsQL as compared to the non-obese CTRL group, while there were no significant differences in subscores from the emotional and school domains. In contrast to the subjects without mobility impairment, there were no significant differences between the sub-scores of the obese and non-obese subjects with spinal cord dysfunction secondary to SCI or SB. The mean total PedsQL score of the non-obese control group (87.7 +/- 2.1) was significantly higher than the obese control group (75.2 +/- 3.4, p < 0.02), which in turn was significantly higher than the SCI group (63.7 +/- 2.2, p < 0.02), and the SB group (63.0 +/- 2.2, p < 0.02). CONCLUSION Patients with SCI and SB have significantly lower HRQOL than children and adolescents without mobility impairments. Whereas obesity significantly reduces the quality of life scores of adolescents without mobility impairments, it has no significant incremental effect on subjects with SCI or SB.
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Affiliation(s)
- Richard Ted Abresch
- University of California Davis School of Medicine, Davis, California 95616, USA.
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