Psychiatric diagnoses in children and adolescents with chronic kidney disease

Background: Children with chronic kidney disease (CKD) are subject to a myriad of complex physical and psychosocial challenges, which may confer increased risk of developing a psychiatric disorder when compared with the general population. Currently available studies are limited by small sample size, narrow geographic region, or inconsistent disease definitions. This study uses a large multi-institutional database of children with CKD in comparison to a national population database to assess differences in key psychiatric diagnoses. Methods: We used parent-report surveys from the Chronic Kidney Disease in Children (CKiD) study baseline assessments and the National Survey of Children’s Health (NSCH) to evaluate the prevalence of depression, anxiety, and attention deficit and hyperactivity disorder (ADHD) diagnoses in children with CKD in comparison to the general population. Children and adolescents ages 2 to 17 who saw a medical provider in the year prior to evaluation were included. Using logistic regression with Poisson distribution, we determined the prevalence ratio (PR) comparing the above diagnoses in children at the time of their entry into the CKiD study to those participants in the NSCH, both overall and within categories based on sex, race, and maternal education status. Analysis was conducted separately for mild (stage 1-2), moderate (stage 3), severe (stage 4-5), and for all stages of CKD. Models were adjusted for age, sex, and race differences. Results: A total of 875 subjects with CKD and 72,699 controls met inclusion criteria. Of the former, 109 subjects had mild CKD, 447 had moderate CKD, and 316 had severe CKD. Those with CKD had aPR of 1.32 (95%CI 1.01 to 1.74) for a diagnosis of depression, 0.72 (95%CI .52 to 0.99) for anxiety, and 0.62 (95%CI 0.48 to 0.80) for ADHD compared to the general population. The pattern of results differed little according to sex, race, or maternal education. There were no appreciable differences in the PRs in subsets of children with mild, moderate, and severe CKD. Discussion: In this analysis, children with CKD demonstrated slightly higher prevalence of depression and lower prevalence of anxiety and ADHD as compared to a general population. There was no evidence that this association differed in those with more advanced CKD or within strata of sex, race/ethnicity, or maternal education status. This is not consistent with the results of other studies which have observed a higher prevalence of psychiatric diagnoses in children with CKD compared to other children , particularly in children with more severe kidney disease. These inconsistencies suggest that this subset of the CKiD data may have limited utility in evaluating history of mental health disorders and that further adjustment and evaluation of baseline data collection is needed.