495 - Environmental stress in children with chronic kidney disease and their families

Publication Number: 2481.495

Judith S. VanSickle, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Darcy Weidemann, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Bradley A. Warady, Children's Mercy Kansas City, Kansas City, MO, United States

Background: Children with end-stage kidney disease (ESKD) face a poor quality of life along with high caregiver burnout. Children with chronic kidney disease (CKD) also have increased exposure to Adverse Childhood Events (ACEs), although previous studies only documented 5 of the 10 ACEs. While our earlier work showed that family support and caregiver involvement predicted preemptive kidney transplants (PKT) and earlier transplantation, little is known about the social and environmental stressors impacting families with children with CKD, especially when complicated by exposure to ACEs.

Objective: Children with CKD and their families experience higher environmental stress.

Design/Methods: Prospective observational study of children and adolescents (birth to 22 years) with CKD stage 3-5 and their families. Participants between 12-22 years and their caregivers completed validated surveys with questions about socio-economic status, caregiver stress, and social connectivity: (PRAPEL: Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences), adverse childhood events (ACE) rated on 10 points, and social connectivity (SSQ6: social support questionnaire-6). Kidney function was assessed using the CKiD U25 eGFR equation. Descriptive statistics were performed using mean ± standard deviation (SD) or median and Interquartile Range (IQR) for continuous data. Fisher's exact and two-sample T-test or Wilcoxon rank-sum (Mann-Whitney) tests were used to compare demographics and family characteristics between GN and non-GN groups and high (2 or more) and low (0-1) ACE groups.

Results: Demographic and clinical data for 40 children and families (35 surveys completed) are presented (Table 1), stratified by GN and Non-GN. Children with Non-GN-CKD were younger (p=0.043), their families experienced less social connectivity (p=0.003), and more stress (p=0.009) compared to participants with GN CKD. Families of children with CKD stages 4-5 reported lower SSQ6 scores, lower parental social connectivity scores, and higher parental stress levels, but these differences were statistically insignificant. When we compared the high versus low ACEs groups per parental report (Table 2), 19.5% reported a high score (6.5, 3-7). The two groups differed significantly in the clinic no-show rate (p < 0.0001).

Conclusion(s): Children and families report more social isolation as parental stress rises, even before ESKD. Non-GN CKD may increase caregiver burnout. Families with higher no-show rates face more environmental stress. Focus should be on ACEs' impact on stress and building family support, which affects KT access.

Table 1. Demographic and characteristics of the cohort.
Mean ± standard deviation (SD) or median and Interquartile Range (IQR) provided for continuous data.
CKD: chronic kidney disease
GN: CKD due to glomerulopathies
Non-GN: CKD due to non-glomerular conditions
SSQ-6: Social Support Questionnaire-6


Table 2: Comparison of low and high ACE scores.
Mean ± standard deviation (SD) or median and Interquartile Range (IQR) provided for continuous data.
CKD: chronic kidney disease
GN: CKD due to glomerulopathies
Non-GN: CKD due to non-glomerular conditions
SSQ6: Social Support Questionnaire-6
ACEs: Adverse Childhood Events