Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Pediatr Nephrol. 2023 Dec;38(12):4127-4136. doi: 10.1007/s00467-023-06069-8. Epub 2023 Jul 10.
Few longitudinal studies have evaluated the impact of chronic kidney disease (CKD) duration on health-related quality of life (HRQOL). The study's aim was to determine how HRQOL changes over time in childhood CKD.
Study participants were children in the chronic kidney disease in children (CKiD) cohort who completed the pediatric quality of life inventory (PedsQL) on three or more occasions over the course of two or more years. Generalized gamma (GG) mixed-effects models were applied to assess the effect of CKD duration on HRQOL while controlling for selected covariates.
A total of 692 children (median age = 11.2) with a median of 8.3 years duration of CKD were evaluated. All subjects had a GFR greater than 15 ml/min/1.73 m. GG models with child self-report PedsQL data indicated that longer CKD duration was associated with improved total HRQOL and the 4 domains of HRQOL. GG models with parent-proxy PedsQL data indicated that longer duration was associated with better emotional but worse school HRQOL. Increasing trajectories of child self-report HRQOL were observed in the majority of subjects, while parents less frequently reported increasing trajectories of HRQOL. There was no significant relationship between total HRQOL and time-varying GFR.
Longer duration of the disease is associated with improved HRQOL on child self-report scales; however, parent-proxy results were less likely to demonstrate any significant change over time. This divergence could be due to greater optimism and accommodation of CKD in children. Clinicians can use these data to better understand the needs of pediatric CKD patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
很少有纵向研究评估慢性肾脏病（CKD）持续时间对健康相关生活质量（HRQOL）的影响。本研究旨在确定儿童 CKD 患者的 HRQOL 随时间的变化情况。
研究参与者为慢性肾脏病儿童（CKiD）队列中的儿童，他们在两年或更长时间内完成了三次或以上的儿科生活质量量表（PedsQL）。广义伽马（GG）混合效应模型用于评估 CKD 持续时间对 HRQOL 的影响，同时控制了选定的协变量。
共评估了 692 名儿童（中位年龄 11.2 岁），CKD 持续时间中位数为 8.3 年。所有患者的肾小球滤过率均大于 15 ml/min/1.73 m。使用儿童自我报告 PedsQL 数据的 GG 模型表明，CKD 持续时间较长与总 HRQOL 和 HRQOL 的 4 个领域的改善有关。使用父母代理 PedsQL 数据的 GG 模型表明，持续时间较长与更好的情绪相关，但与更差的学校 HRQOL 相关。在大多数患者中观察到儿童自我报告 HRQOL 的递增轨迹，而父母报告 HRQOL 的递增轨迹则较少。总 HRQOL 与时间变化的肾小球滤过率之间无显著关系。
疾病持续时间较长与儿童自我报告量表上的 HRQOL 改善相关；然而，父母代理的结果不太可能随着时间的推移显示出任何显著变化。这种差异可能是由于儿童对 CKD 的乐观态度和适应能力更强。临床医生可以使用这些数据更好地了解儿科 CKD 患者的需求。更高分辨率的图表摘要版本可作为补充信息提供。
