Carlson Joann, Gerson Arlene C, Matheson Matthew B, Manne Sharon, Warady Bradley A, Hooper Stephen R, Lande Marc, Harshman Lyndsay A, Johnson Rebecca J, Shinnar Shlomo, Kogon Amy J, Furth Susan
Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Pediatr Nephrol. 2020 Sep;35(9):1659-1667. doi: 10.1007/s00467-020-04569-5. Epub 2020 Apr 24.
To evaluate impact of anemia on health-related quality of life (HRQOL) over time in a large pediatric cohort with mild-to-moderate chronic kidney disease (CKD).
Participants were enrolled in the Chronic Kidney Disease in Children Study (CKiD), a multicenter, longitudinal cohort. HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL). Anemia was defined as hemoglobin < 5th percentile for age, sex, and race. Two longitudinal analyses were conducted on consecutive visit pairs. Models examined effects of anemia status on both HRQOL score over time and change in HRQOL score between consecutive visits. The sample included 733 children with a median estimated GFR 54 ml/min/1.73 m. Thirty percent of children had anemia at index visit.
Analysis of HRQOL scores revealed the presence of anemia was associated with significantly lower overall HRQOL (β = - 2.90 (95% CI = - 7.74, - 0.21), p = 0.04) and physical functioning (β = - 5.72 (- 9.49, - 2.25), p = 0.001) according to children. On parent ratings, the development of anemia was associated with lower emotional functioning scores (β = - 4.87 (- 8.72, - 0.11), p = 0.045). In the second model, children who developed anemia were rated by caregivers as having more decreased physical functioning than children who remained anemia-free (β = - 3.30 per year (- 5.83, - 0.76), p = 0.01). Caregivers did not observe declines in their children's other PedsQL subscales in the presence of developed anemia. Children with resolved or persistence did not show improvement or decline in any aspect of HRQOL functioning relative to non-anemic subjects.
In children with CKD, anemia has an adverse effect on HRQOL which persists over time but does not appear to be progressive.
评估贫血对一大群患有轻至中度慢性肾脏病（CKD）的儿童健康相关生活质量（HRQOL）随时间的影响。
参与者被纳入儿童慢性肾脏病研究（CKiD），这是一项多中心纵向队列研究。使用儿童生活质量量表（PedsQL）测量HRQOL。贫血定义为血红蛋白低于年龄、性别和种族的第5百分位数。对连续的访视对进行了两项纵向分析。模型研究了贫血状态对HRQOL评分随时间的影响以及连续访视之间HRQOL评分的变化。样本包括733名儿童，估计肾小球滤过率（GFR）中位数为54 ml/min/1.73 m²。30%的儿童在首次访视时患有贫血。
对HRQOL评分的分析显示，根据儿童自身报告，贫血的存在与总体HRQOL显著降低（β = -2.90（95%CI = -7.74，-0.21），p = 0.04）和身体功能（β = -5.72（-9.49，-2.25），p = 0.001）相关。根据家长评分，贫血的发生与较低的情绪功能评分相关（β = -4.87（-8.72，-0.11），p = 0.045）。在第二个模型中，与未患贫血的儿童相比，出现贫血的儿童被照料者评定为身体功能下降更多（每年β = -3.30（-5.83，-0.76），p = 0.01）。在出现贫血的情况下，照料者未观察到其子女的其他PedsQL子量表有下降。贫血得到缓解或持续存在的儿童在HRQOL功能的任何方面相对于非贫血受试者均未显示出改善或下降。
在患有CKD的儿童中，贫血对HRQOL有不良影响，这种影响会持续存在，但似乎不会进展。
