Kidney Function

Background: Although symptoms of sleepiness and fatigue are common in adults with chronic kidney disease (CKD), little is known about the prevalence of these symptoms in children with CKD.Study Design: Cross-sectional analysis within a cohort study.Setting & Participants: We describe the frequency and severity of sleep problems and fatigue and assess the extent of their association with measured glomerular filtration rate (mGFR) and health-related quality of life (HRQOL) in 301 participants of the Chronic Kidney Disease in Children cohort.Outcomes & Measurements: Sleep and fatigue-related items from the Pediatric Quality of Life Inventory 4.0 Generic Scales and the CKD-related Symptoms List were used.Results: Median mGFR was 42.0 mL/min/1.73 m2 (25th-75th percentiles, 31.2-53.2), and median age was 13.9 years (25th-75th percentiles, 10.8-16.2). Children with mGFR of 40-<50, 30-<40, or <30 mL/min/1.73 m2 had 2.07 (95% CI, 1.05-4.09), 2.35 (95% CI, 1.17-4.72), and 2.59 (95% CI, 1.15-5.85) higher odds of having more severe parent reports of low energy than children with mGFR ≥ 50 mL/min/1.73 m2. Compared with participants with mGFR ≥ 50 mL/min/1.73 m2, those with mGFR < 30 mL/min/1.73 m2 had 3.92 (95% CI, 1.37-11.17) higher odds of reporting more severe weakness, and those with mGFR of 40-<50 mL/min/1.73 m2 had 2.95 (95% CI, 1.26-6.88) higher odds of falling asleep during the day. Low energy, trouble sleeping, and weakness were associated with lower HRQOL scores.Limitations: Symptoms of sleep and fatigue represent the child’s or parent’s perception of symptom severity, whereas individual items can lead to imprecise measurements of sleep and fatigue.Conclusions: Lower mGFR was associated with increased weakness, low energy, and daytime sleepiness. Furthermore, a strong association between trouble sleeping, low energy, and weakness with decreases in overall HRQOL was observed. Detection and treatment of poor sleep and fatigue may improve the development and HRQOL of children and adolescents with CKD.

Background: Previous analyses report the impact of erythropoiesis-stimulating agents (ESAs) on health-related quality of life across various populations. In this analysis, we review published studies and quantify the effect of ESA therapy on energy/fatigue and physical function in nondialysis patients with chronic kidney disease (CKD) related anemia.Study Design: Systematic literature search to identify articles (1980-2008) that evaluated effects of ESAs on patient-reported energy and physical function.Setting & Population: Nondialysis CKD patients with anemia enrolled in prospective trials.Selection Criteria for Studies: Prospective studies measuring energy or physical function with both baseline and follow-up measurement.Intervention: ESA treatment.Outcomes: Improvements in energy and physical function assessed using effect size, a measure of treatment responsiveness.Results: 14 studies were identified: 11 measured energy and 14 measured physical function. The 36-Item Short-Form Health Survey (SF-36) was the most common instrument used to report energy and physical function. Of 11 studies measuring energy, 2 were double-blind randomized placebo-controlled trials (RCTs), 5 were open-label RCTs, and 4 were single-arm open-label studies. Eight of 11 studies reported statistically significant improvements in energy. Effect size for energy ranged from small (0.24) to large (1.90) in ESA-treated groups and was moderate in each arm of the low- versus high-hemoglobin target RCTs. Of 14 studies measuring physical function, 2 were double-blind RCTs, 6 were open-label RCTs, and 6 were single-arm open-label studies. Ten of 14 studies reported statistically significant improvements in physical function. Effect size for physical function ranged from small (0.37) to large (2.38) in ESA-treated groups and was negligible to moderate in each arm of low- versus high-hemoglobin target studies.Limitations: Findings and conclusions were limited by the available evidence.Conclusion: RCTs and single-arm studies indicate that treatment of anemia with ESAs improves energy and physical function in nondialysis CKD patients.

Watch the trials and tribulations of Seymour Jones as he tries to make the public aware of Chronic Kidney Disease warning signs. Produced by Renal Support Network and Directed by Stephen Furst. www.RSNhope.org (less)