Fatigue and Quality of Life in Children with Chronic Kidney Disease

Abstract

Background: This study investigates the effect of chronic kidney disease (CKD) stage on fatigue and health-related quality of life (HRQoL) in the pediatric population. Material and Methods: The PedsQL (Pediatric Quality of Life Inventory) Multidimensional Fatigue Scale (subcategories: general, sleep/rest, and cognitive fatigue) and HRQoL Generic Core Scales (subcategories: physical, emotional, social, and school functioning) questionnaires were completed by 30 patients aged from 7 to 18 years old with CKD stage 2–4, CKD stage 5 on dialysis (CKD 5D), and kidney transplantation (KTx), as well as their parents. Results: Both low “Total Fatigue” and “Total HRQoL” scores were reported in 16.7% of patients. “Sleep/Rest Fatigue”, “Emotional Functioning”, and “School functioning” were the lowest scored subcategories. CKD 5D/KTx patients presented lower “Sleep/Rest Fatigue” (p = 0.022) and, more frequently, low “School Functioning” scores (p = 0.029). The “Total HRQoL” score was correlated to the “Total Fatigue” score (rs = 0.625, p < 0.001). A low “Sleep/Rest Fatigue” score was associated with low “Physical Functioning”, “School Functioning”, and “Total HRQoL” scores (p = 0.016, p = 0.001, and p = 0.047 respectively). Parents’ HRQoL score was lower than patients’ score on “Physical Functioning” (p = 0.040) and “School Functioning” subcategories (p = 0.045). Conclusions: Fatigue and disturbed HRQoL are mostly observed in CKD 5D and KTx pediatric patients, and are associated with sleep disorders and school dysfunction. Fatigue affects HRQoL, which is perceived as more deteriorated by the patients’ parents.

Integrated Collection of Patient-Reported Outcomes and Experiences in Children with Kidney and Hematological Diseases: A Pilot Study

“…We have observed the lowest emotional and school functioning scores in our population of children with kidney and hematological diseases, which are in line with previous findings in comparable populations [23,24]. This highlights the need for intervention to improve QoL within these domains.…”

Fatigue assessment and its predictors in pediatric patients with chronic kidney disease stages III to V

“…Nevertheless, the scales sufficiently address the perceived impact of fatigue in general. Despite that preschool children were not included, Pediatric-specific assessments such as that of Karava et al [ 22], published towards the end of our study, could add further value in future studies.…”

Malnutrition Patterns in Children with Chronic Kidney Disease

“…Reduced physical literacy, defined as lack of confidence and motivation in physical activity due to psychological factors, was observed in the CKD pediatric population [ 52 ]. Furthermore, sleep/rest fatigue, mostly observed in dialysis and kidney transplant recipients, was also associated with poor physical functioning [ 54 ]. Moreover, dynapenia, which will be described in the following sections may also contribute to impaired physical performance.…”

“…The growing body of clinical evidence in CKD pediatric populations underline that muscle wasting is associated with general fatigue, deteriorating life quality, and with decreased exercise capacity, jeopardizing cardiorespiratory fitness [ 54 , 56 , 62 , 63 ]. Moreover, although the muscle–bone unit is impaired in CKD, muscle wasting possibly contributes to bone deficits, resulting in decline of musculoskeletal health [ 56 , 61 , 64 , 65 ].…”

“…Physical activity questionnaires for children (PAQ-C) and adolescents (PAQ-A) have been proven effective for evaluating exercise deficit disorders in CKD pediatric patients [ 50 , 51 ]. Estimation of fatigue, adapted to pediatric population multidimensional fatigue questionnaires (PedsQL-MFS) may be also useful for the diagnosis of frailty and poor physical functioning [ 54 , 64 ]. Reduced exercise capacity in adult populations is mostly assessed by using the Short Physical Performance Battery (SPPB), which includes usual gait speed, 6 min walk test (6MWT) and the stair climb power test [ 6 ].…”