Department of Pediatrics, Renal Section, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
Department of Paediatrics, Mulago National Referral Hospital, Kampala, Uganda.
Pediatr Nephrol. 2021 Feb;36(2):323-331. doi: 10.1007/s00467-020-04705-1. Epub 2020 Jul 31.
Limited data exist about causes of chronic kidney disease (CKD) and impact on health-related quality of life (HRQoL) in African children. We evaluated types of kidney disease in Ugandan children 0-18 years and compared HRQoL in children with CKD or with benign or resolving kidney disease (non-CKD) to assess predictors of HRQoL.
Demographic, socioeconomic, and clinical data were obtained for this cross-sectional study. Pediatric Quality of Life Core Scale™ (PedsQL) was used to survey 4 domains and overall HRQoL. CKD and non-CKD scores were compared using unpaired t test. HRQoL predictors were evaluated using linear and logistic regression analyses.
One hundred forty-nine children (71 CKD, 78 non-CKD; median age 9 years; male 63%) had the following primary diseases: nephrotic syndrome (56%), congenital anomalies of the urinary tract (CAKUT) (19%), glomerulonephritis (17%), and other (8%). CAKUT was the predominant etiology (39%) for CKD; 63% had advanced stages 3b-5. Overall HRQoL scores were significantly lower for CKD (57 vs. 86 by child report, p < 0.001; 63 vs. 86 by parent proxy report, p < 0.001). Predictors of lower HRQoL were advanced CKD stages 3b-5, primary caregiver non-parent, vitamin D deficiency, and anemia.
Like other parts of the world, CAKUT was the main cause of CKD. Most CKD children presented at late CKD stages 3b-5. Compared with non-CKD, HRQoL in CKD was much lower; only two-thirds attended school. Vitamin D deficiency and anemia were potentially modifiable predictors of low HRQoL. Interventions with vitamin D, iron, and erythropoietin-stimulating agents might lead to improved HRQoL.
关于慢性肾脏病（CKD）的病因以及对非洲儿童健康相关生活质量（HRQoL）的影响，相关数据有限。我们评估了乌干达 0-18 岁儿童的肾脏疾病类型，并比较了 CKD 儿童与良性或缓解性肾脏疾病（非 CKD）儿童的 HRQoL，以评估 HRQoL 的预测因素。
本横断面研究收集了人口统计学、社会经济学和临床数据。使用儿科生活质量核心量表（PedsQL）调查了 4 个领域和整体 HRQoL。使用未配对 t 检验比较 CKD 和非 CKD 评分。使用线性和逻辑回归分析评估 HRQoL 预测因素。
149 名儿童（71 名 CKD，78 名非 CKD；中位年龄 9 岁；男性 63%）患有以下主要疾病：肾病综合征（56%）、先天性尿路异常（CAKUT）（19%）、肾小球肾炎（17%）和其他疾病（8%）。CAKUT 是 CKD 的主要病因（39%）；63%的患儿处于晚期 3b-5 期。CKD 患儿的总体 HRQoL 评分明显较低（患儿报告的 57 分与 86 分相比，p<0.001；家长报告的 63 分与 86 分相比，p<0.001）。HRQoL 较低的预测因素包括晚期 CKD 3b-5 期、主要照顾者非父母、维生素 D 缺乏和贫血。
与世界其他地区一样，CAKUT 是 CKD 的主要病因。大多数 CKD 患儿在晚期 3b-5 期就诊。与非 CKD 相比，CKD 患儿的 HRQoL 明显较低，只有三分之二的患儿上学。维生素 D 缺乏和贫血是 HRQoL 较低的潜在可改变预测因素。维生素 D、铁和促红细胞生成素刺激剂的干预措施可能会改善 HRQoL。
