Chronic kidney disease (CKD) is a common condition in children, affecting approximately 15% of children worldwide. It is associated with various complications, including fatigue. Fatigue is a common symptom in children with chronic kidney disease, and it can significantly impact their quality of life. In this article, we will discuss how children with CKD experience increased burden of fatigue independent of disease severity.

What is CKD?

CKD is a condition in which the kidneys are damaged and cannot filter blood as efficiently as they should. CKD can occur due to various reasons, including diabetes, high blood pressure, infections, and autoimmune diseases. CKD is a progressive disease, which means it gets worse over time.

It can be categorized into different stages based on the level of kidney function. The stages range from stage 1, which is the mildest form of CKD, to stage 5, which is the most severe form of CKD. Stage 5 CKD is also known as end-stage renal disease (ESRD), and it requires dialysis or kidney transplantation to maintain life.

Fatigue in children with CKD

Fatigue is a common symptom in children with chronic kidney disease. It is a feeling of extreme tiredness or lack of energy, which can affect their daily activities. Children with CKD may experience fatigue due to various reasons, including anemia, mineral and bone disorders, poor sleep quality, and psychological distress.

Studies have shown that fatigue is more prevalent in children with chronic kidney disease than in healthy children. A study conducted by Kim et al. (2016) found that 57% of children with CKD reported fatigue, compared to 18% of healthy children. The study also found that fatigue was associated with a lower quality of life in children with CKD.

Impact of fatigue on quality of life

It can significantly impact the quality of life of children with chronic kidney disease. It may experience limitations in their daily activities due to fatigue, such as attending school, participating in sports, and socializing with friends. Fatigue can also affect their emotional well-being, leading to depression and anxiety.

A study conducted by Blydt-Hansen et al. (2019) found that fatigue was associated with lower health-related quality of life in children with CKD. The study also found that children with CKD who reported higher levels of fatigue had more missed school days and lower academic performance.

Factors contributing to fatigue in children with CKD

Various factors can contribute to fatigue in children with chronic kidney disease. Anemia is one of the common causes of fatigue in children with CKD. Anemia occurs when there is a deficiency of red blood cells, which are responsible for carrying oxygen to different parts of the body. In CKD, the kidneys are unable to produce enough erythropoietin, a hormone that stimulates the production of red blood cells, leading to anemia.

Mineral and bone disorders are another factor that can contribute to fatigue in children with CKD. Mineral and bone disorders occur due to abnormalities in the metabolism of calcium, phosphorus, and vitamin D, which can lead to bone pain, weakness, and fatigue.

Poor sleep quality is also a contributing factor to fatigue in children with CKD. Children with CKD may experience sleep disturbances due to various reasons, including restless leg syndrome, sleep apnea, and anxiety.

Psychological distress, including depression and anxiety, can also contribute to fatigue in children with CKD. CKD in children may experience emotional and psychological distress due to the chronic nature of the disease, frequent hospital visits, and restrictions in their daily activities.

Fatigue independent of disease severity

A study conducted by Blydt-Hansen  found that fatigue in children with CKD is not solely dependent on the severity of the disease. The study compared fatigue levels in children with CKD across different stages of the disease and found that fatigue was highest in children with early-stage CKD and did not increase with the severity of the disease.

This suggests that fatigue in children with CKD may be influenced by other factors besides the severity of the disease. For example, children with early-stage CKD may experience more psychological distress due to the uncertainty of the disease’s progression and the potential impact on their future. Additionally, children with early-stage CKD may be more active and have higher expectations of themselves, leading to more fatigue.

Implications for management

The high prevalence of fatigue in children with CKD and its impact on their quality of life highlights the need for effective management strategies. Management strategies for fatigue in children with CKD should be tailored to the underlying cause of the fatigue.

For example, if anemia is the underlying cause of fatigue, treatment with erythropoietin-stimulating agents or iron supplements may be effective. If mineral and bone disorders are the cause of fatigue, treatment with medications such as phosphate binders and vitamin D supplements may be necessary.

Improving sleep quality through non-pharmacological interventions, such as cognitive-behavioral therapy, can also be effective in reducing fatigue in children with CKD. Psychological interventions, such as cognitive-behavioral therapy and mindfulness-based stress reduction, can also be effective in reducing psychological distress and fatigue in children with CKD.

Conclusion

Fatigue is a common symptom in children with CKD and can significantly impact their quality of life. Factors contributing to fatigue in children with CKD include anemia, mineral and bone disorders, poor sleep quality, and psychological distress. Children with CKD is not solely dependent on the severity of the disease and may be influenced by other factors, such as psychological distress and expectations of oneself.

Effective management strategies for fatigue in children with CKD should be tailored to the underlying cause of the fatigue. Treatment options include erythropoietin-stimulating agents, iron supplements, phosphate binders, vitamin D supplements, cognitive-behavioral therapy, and mindfulness-based stress reduction.

Overall, increased awareness of the burden of fatigue in children with CKD and effective management strategies can help improve their quality of life and minimize the impact of the disease on their daily activities.

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