Medida mediante un test específico de la calidad de vida relacionada con la salud en niños con enfermedad renal crónica: Influencia del tratamiento

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Abstract

Introducción: La enfermedad renal crónica (ERC) modifica la vida del paciente y afecta de manera especial a los niños en su etapa de desarrollo personal. En adultos se ha demostrado peor calidad de vida relacionada con la salud (CVRS), sobre todo en hemodiálisis (HD); sin embargo, hay muy pocos datos objetivos sobre CVRS en niños con ERC, la mayoría obtenidos una vez superada la infancia de estos enfermos o con cuestionarios genéricos que no permiten discriminar cambios en una enfermedad específica. Objetivos: Conocer cómo perciben nuestros pacientes su estado de salud midiendo la CVRS y sus áreas más afectadas. Determinar la influencia de los distintos tratamientos y la concordancia entre la opinión de los niños y de sus padres. Material y métodos: Estudio transversal en 71 niños (33 sometidos a trasplante, 11 en diálisis peritoneal, cinco en HD y 22 en tratamiento conservador) y en sus padres. Utilizamos un cuestionario específico desarrollado por nosotros para la medida de CVRS en niños con ERC. En los menores de 9 años sólo contestaron los padres. Resultados: Los niños en HD refieren una peor CVRS, seguidos de los pacientes en diálisis peritoneal (DP) y de los sometidos a trasplante (TX), y la mejor CVRS se obtiene en los pacientes sometidos a tratamiento conservador. Los aspectos que más se ven alterados son la actividad física y la asistencia escolar, sobre todo en HD, hecho en el que coinciden padres e hijos. La concordancia entre padres e hijos fue buena en los mayores de 15 años, existiendo discordancia en los niños de 9 a 15 años.

Translated abstract

Introduction: Chronic kidney disease (CKD) affects the daily life of the child especially during the stage where their personal development takes place. Adult renal patients have a demonstrated worse health related quality of life (HRQL) mainly under hemodialysis (HD), however there are few published data about HRQL in children with CKD, most of them obtained after patient's childhood or with generic tests that do not discriminate changes in a specific disease. Objetive: To assess how our patients perceive their health by measuring the HRQL and its most affected domains. To determine how the different therapies affect the child with CKD and the agreement on the opinion between children and their parents. Material and methods: We included 71 CKD children and their parents in a cross-sectional study ( 33 transplanted, 11 peritoneal dialysis [PD], 5 HD, 22 conservative treatment). We used a specific quality of life test for CKD children that we had previously developed (TECAVNER). If the child was younger than 9 years, only their parents completed the survey. Results: Children on HD refer a worse HRQL followed those who underwent PD and those transplanted. The best HRQL was obtained in children with conservative treatment. Both parents and children agree that the domains more frequently affected are physical activity and school attendance especially those on HD. The way the adolescents 15 years and older perceived their health was similar to that of their parents. This was not the case in the younger group, 9 through 15 years.

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Identification and management of psychosocial problems by preventive child health care.

E Brugman, S A Reijneveld, F C Verhulst … (2001)

To assess the degree to which physicians and nurses working in preventive child health care (child health professionals [CHPs]) identify and manage psychosocial problems in children, and to determine its association with parent-reported behavioral and emotional problems, sociodemographic factors, and general and mental health history of children. The CHPs examined the child and interviewed parents and child during their routine health assessments. The parents completed the Child Behavior Checklist. Nineteen child health care services across the Netherlands, serving nearly all school-aged children routinely. Of 4970 children aged 5 through 15 years, eligible for a routine health assessment, 4480 (90.1%) participated. Identification and management of psychosocial problems by CHPs. In 25% of all children, CHPs identified 1 or more psychosocial problems. One in 5 identified children were referred for further diagnosis and treatment. Identification of psychosocial problems and subsequent referral were 6 times more likely in children with serious parent-reported problem behavior according to the Child Behavior Checklist total problem score (8% of total sample). However, CHPs identified no psychosocial problems in 43% of these children and therefore undertook no action. Other child factors associated with CHPs' identification and referral were past treatment for psychosocial problems, life events, and academic problems. After adjustment for these, sociodemographic characteristics did not predict referral. The CHPs identify psychosocial problems in school-aged children frequently and undertake actions for most of them. Screening for psychosocial problems may be a promising option to reduce these problems, but accurate identification should be enhanced.