Shawn Khullar1,2, Tonny Banh1, Jovanka Vasilevska-Ristovska1, Rahul Chanchlani3,4, Josefina Brooke5, Christoph P B Licht5,6,7, Michele Reddon5, Seetha Radhakrishnan5,6, Monica Piekut5, Valerie Langlois5,6, Kim Aitken-Menezes5, Rachel J Pearl5,6,8, Diane Hebert5,6, Damien Noone5,6, Rulan S Parekh9,10,11,12,13. 1. Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. 2. Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland. 3. Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8S 4K1, Canada. 4. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 5. Division of Nephrology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. 6. University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. 7. Program in Cell Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada. 8. Division of Nephrology, William Osler Health Systems, 20 Lynch Street, Brampton, ON, L6W 2Z8, Canada. 9. Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. rulan.parekh@sickkids.ca. 10. Division of Nephrology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. rulan.parekh@sickkids.ca. 11. University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. rulan.parekh@sickkids.ca. 12. University Health Network, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. rulan.parekh@sickkids.ca. 13. Dalla Lana School of Public Health, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. rulan.parekh@sickkids.ca.
Abstract
BACKGROUND: Steroids and/or steroid-sparing medications are commonly used for nephrotic syndrome treatment; however, the impact of these medications on health-related quality of life over time is not well described. METHODS: Longitudinal cohort is up to 5 years where children were assessed with baseline and annual Pediatric Quality of Life Inventory questionnaire. A mixed-effects linear regression determined differences in scores among children receiving steroids and/or steroid-sparing agents for at least 30 days compared with those not on medication at 1, 3, 6, and 12 months prior to assessment. RESULTS: Among 295 children, 64% were male, with a median age of 3.7 (interquartile range [IQR], 2.7, 5.9) years at diagnosis, and comprised 25% Europeans, 40% South Asians, and 8% East/Southeast Asians. Adjusted HRQOL scores were reduced among children taking steroids and steroid-sparing agents among 705 HRQOL measures (median 2 [IQR, 1, 3] per child). Compared to children without medication, steroid and steroid-sparing agent use up to 12 months prior to assessment were associated with an overall HRQOL drop of 3.17 (95% confidence interval [CI], - 5.25, - 1.08) and 3.18 (95% CI, - 5.24, - 1.12), respectively, after adjustment. Functioning domain scores were reduced by 4.41 points (95% CI, - 6.57, - 2.25) in children on steroids, whereas fatigue domain scores were reduced by 5.47 points (95% CI, - 9.28, - 1.67) in children on steroid-sparing agents after adjustment. CONCLUSIONS: HRQOL is consistently decreased in children receiving steroids and steroid-sparing agents, with differential effects on functioning and fatigue. Counseling families on possible effects of prolonged treatment periods is important in the management of childhood nephrotic syndrome.
BACKGROUND: Steroids and/or steroid-sparing medications are commonly used for nephrotic syndrome treatment; however, the impact of these medications on health-related quality of life over time is not well described. METHODS: Longitudinal cohort is up to 5 years where children were assessed with baseline and annual Pediatric Quality of Life Inventory questionnaire. A mixed-effects linear regression determined differences in scores among children receiving steroids and/or steroid-sparing agents for at least 30 days compared with those not on medication at 1, 3, 6, and 12 months prior to assessment. RESULTS: Among 295 children, 64% were male, with a median age of 3.7 (interquartile range [IQR], 2.7, 5.9) years at diagnosis, and comprised 25% Europeans, 40% South Asians, and 8% East/Southeast Asians. Adjusted HRQOL scores were reduced among children taking steroids and steroid-sparing agents among 705 HRQOL measures (median 2 [IQR, 1, 3] per child). Compared to children without medication, steroid and steroid-sparing agent use up to 12 months prior to assessment were associated with an overall HRQOL drop of 3.17 (95% confidence interval [CI], - 5.25, - 1.08) and 3.18 (95% CI, - 5.24, - 1.12), respectively, after adjustment. Functioning domain scores were reduced by 4.41 points (95% CI, - 6.57, - 2.25) in children on steroids, whereas fatigue domain scores were reduced by 5.47 points (95% CI, - 9.28, - 1.67) in children on steroid-sparing agents after adjustment. CONCLUSIONS: HRQOL is consistently decreased in children receiving steroids and steroid-sparing agents, with differential effects on functioning and fatigue. Counseling families on possible effects of prolonged treatment periods is important in the management of childhood nephrotic syndrome.
Entities:
Keywords:
Corticosteroids; HRQOL (health-related quality of life); PedsQL (pediatric quality of life inventory); Steroid-sparing medications