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Chronic kidney disease impacts health-related quality of life of children in Uganda, East Africa

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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 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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

The investigators are grateful to the staff of the Mulago National Referral Hospital Adult and Pediatrics Renal Clinics, study staff, and the children and their caregivers who participated in this study. Special thanks to the administrative staff at the Baylor Pediatrics Infectious Diseases Clinic, Uganda, for grant management. Special thanks to the Mapi Research Trust for permission to use the Pediatric Quality of Life Core Scale™ assessment tools.

Funding

This work was supported by an Early Career Program Award (Grant 12754) of the Thrasher Research Fund for Dr. Peace Imani at Texas Children’s Hospital/Baylor College of Medicine, Houston, Texas.

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Authors and Affiliations

  1. Department of Pediatrics, Renal Section, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA

    Peace D. Imani, Poyyapakkam Srivaths & Eileen D. Brewer

  2. Department of Paediatrics, Mulago National Referral Hospital, Kampala, Uganda

    Judith Aujo & Sarah Kiguli

  3. College of Health Sciences, Makerere University, Kampala, Uganda

    Sarah Kiguli

Authors
  1. Peace D. Imani
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  2. Judith Aujo
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  3. Sarah Kiguli
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  4. Poyyapakkam Srivaths
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  5. Eileen D. Brewer
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Contributions

Dr. Imani conceived and designed the study; applied for the grant; performed data collection, analyses, and interpretation of the data; and drafted the manuscript. Dr. Aujo was the study coordinator and clinic pediatrician. Dr. Kiguli was Dr. Imani’s study mentor in Uganda. Dr. Brewer is Dr. Imani’s mentor in Texas. Drs. Srivaths and Brewer assisted with proposal writing, study design, interpretation of data, and critical review of the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Peace D. Imani.

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Conflict of interest

The authors declare that they have no conflict of interest.

Consent to participate

Consent was obtained from all parents or caregivers, and assent obtained from children who were 8 years or older.

Ethics approval

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.

Disclaimer

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The findings and conclusions contained within the manuscript are those of the authors and do not necessarily reflect positions or policies of the Thrasher Research Fund.

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Imani, P.D., Aujo, J., Kiguli, S. et al. Chronic kidney disease impacts health-related quality of life of children in Uganda, East Africa. Pediatr Nephrol 36, 323–331 (2021). https://doi.org/10.1007/s00467-020-04705-1

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  • DOI: https://doi.org/10.1007/s00467-020-04705-1

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