Chronic Kidney Disease Impacts Health-Related Quality of Life of Children in Uganda, East Africa

Abstract

Background: 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 renal disease in Ugandan children 0-18 years and compared HRQoL in children with CKD or with benign or resolving renal disease (non-CKD) to assess predictors of HRQoL. Methods: Demographic, socioeconomic and clinical data were obtained for this cross-sectional study. Pediatric Quality of Life Core ScaleTM (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. Findings: 149 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<0.0001; 63 vs. 86 by parent proxy report, p<0.0001). Predictors of lower HRQoL were advanced CKD stages 3b-5, primary caregiver non-parent, vitamin D deficiency and anemia. Interpretation: Like other parts of the world, CAKUT was the main cause of CKD. Most CKD children presented at late CKD stages 3b-5. Compared to 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. Funding Statement: Early Career Program Award (Grant 12754) of the Thrasher Research Fund. Declaration of Interests: The authors of this manuscript have no conflicts of interest to disclose. Ethics Approval Statement: At enrollment after explanation of the study objectives, relevance, risks and benefits, informed consent was obtained from all parents or caregivers, and assent obtained from children who were eight years or older. This study was approved by the Baylor College of Medicine Institutional Review Board, the Makerere University Faculty of Medicine and Mulago Hospital Research and Ethics Committees, and the Uganda National Council of Science and Technology.