Sleep and Fatigue Symptoms in Children and Adolescents With CKD: A Cross-sectional Analysis From the Chronic Kidney Disease in Children (CKiD) Study

Roumelioti, Maria-Eleni; Wentz, Alicia; Schneider, Michael F.; Gerson, Arlene C.; Hooper, Stephen; Benfield, Mark; Warady, Bradley A.; Furth, Susan L.; Unruh, Mark L.

doi:10.1053/j.ajkd.2009.09.021

« Previous Next »American Journal of Kidney Diseases
Volume 55, Issue 2 , Pages 269-280, February 2010

Sleep and Fatigue Symptoms in Children and Adolescents With CKD: A Cross-sectional Analysis From the Chronic Kidney Disease in Children (CKiD) Study

Maria-Eleni Roumelioti, MD
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA
- Address correspondence to Maria-Eleni Roumelioti, MD, University of Pittsburgh Medical Center, Renal-Electrolyte Division, 200 Lothrop St, PUH C-1111, Pittsburgh, PA 15213
Alicia Wentz, MA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Michael F. Schneider, MS
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Arlene C. Gerson, MD, PhD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
Stephen Hooper, PhD
- Department of Psychiatry and Clinical Center for the Study of Development and Learning, University of North Carolina, Chapel Hill, NC
Mark Benfield, MD
- Department of Pediatrics, University of Alabama at Birmingham, School of Medicine, Birmingham, AL
Bradley A. Warady, MD
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
Susan L. Furth, MD, PhD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
Mark L. Unruh, MD, MSc
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA

Received 12 May 2009; accepted 14 September 2009. published online 25 December 2009.

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.

Index Words: Children, adolescents, chronic kidney disease, sleep, fatigue, glomerular filtration rate, health-related quality of life