492 - Longitudinal Family Functioning Trajectories and the Role of Caregiver Distress in Pediatric Nephrotic Syndrome

Publication Number: 1472.492

Suud S. Nahdi, The Hospital for Sick Children, Toronto, ON, Canada; Cal Robinson, The Hospital for Sick Children, Toronto, ON, Canada; Nowrin Aman, The Hospital for Sick Children, Toronto, ON, Canada; Josefina A. Brooke, the Hospital for Sick Children, Toronto, ON, Canada; Valentina Bruno, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Vaneet Dhillon, The Hospital for Sick Children, Toronto, ON, Canada; Mackenzie Garner, The Hospital for Sick Children, Toronto, ON, Canada; Damien Noone, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Rachel Pearl, The Hospital for Sick Children, Toronto, ON, Canada; Seetha Radhakrishnan, The Hospital for Sick Children, Toronto, ON, Canada; Nithiakishna Selvathesan, The Hospital for Sick Children, Toronto, ON, Canada; Chia Wei Teoh, The Hospital for Sick Children, Toronto, ON, Canada; Jovanka Z. Vasilevska, The Hospital for Sick Children, Toronto, ON, Canada; Rulan Savita. Parekh, women's College Hospital, Toronto, ON, Canada

Background: Nephrotic syndrome is a chronic relapsing-remitting childhood kidney disease that places substantial psychosocial demands on families. Family functioning strongly influences treatment adherence and child well-being. Despite this, longitudinal data on family functioning over time in nephrotic syndrome is limited.

Objective: To examine trajectories of family functioning over time in children with nephrotic syndrome and to identify demographic, clinical, and psychosocial predictors of poorer functioning.

Design/Methods: This longitudinal cohort analysis used data from the Insight into Nephrotic Syndrome study: Investigating Genes, health and Therapeutics, a longitudinal cohort study which follows children diagnosed with nephrotic syndrome between 1996-2023 across multiple centers in Greater Toronto and Hamilton area, Canada. Family functioning was measured using the McMaster Family Assessment Device (FAD) General Functioning Scale (1-4, lower = healthier). A linear mixed-effects model with random intercepts and slopes for time was fit to account for repeated measures within families. Fixed effects included demographic, clinical, and psychosocial variables.

Results: A total of 554 families (1,727 observations) were included, with a mean of 2.8 visits per family and a mean follow-up duration of 1.5 years. At baseline, the mean age at diagnosis was 4.8 ± 3.2 years, and 65% of children were male. Thirty-eight percent were receiving corticosteroids (prednisone) and 20% were on a steroid-sparing agent. Seventy-five percent of families were immigrant, and 57% had postsecondary education.
Baseline family functioning was generally healthy (mean FAD = 2.02 ± 0.12 on a 1–4 scale, lower = better). Family functioning remained stable with a slight improvement over time (β = −0.009 per year, p = 0.005). Mean caregiver distress (PHQ-4) was 1.5 ± 2.3 and was independently associated with poorer functioning (β = +0.012 per point, p < 0.001) however it did not influence the rate of change over time (time × PHQ-4, p = 0.87; Figure 1). Other sociodemographic and clinical covariates, including steroid exposure, were not significant predictors of family functioning trajectories.

Conclusion(s): Family functioning in pediatric nephrotic syndrome appears stable overall, though caregiver stress predicts poorer functioning signalling vulnerability. Targeted interventions addressing caregiver mental health supports may strengthen family resilience in chronic pediatric kidney disease.

Family Functioning Trajectories Over Time for Children with Nephrotic Syndrome
PAS Figure 1.jpegEffect of caregiver distress (PHQ-4) on family functioning for children with nephrotic syndrome