The impact of chronic kidney disease on chronic school absenteeism

Background: School absenteeism is an important predictor of low academic success. Children with chronic illness are at increased risk of school absenteeism due to disease-specific and psychosocial factors. The prevalence of chronic school absenteeism is not well described in the chronic kidney disease (CKD) population. Objective: The purpose of this study was to document the frequency of chronic school absenteeism among children with mild to moderate CKD and compare this to the corresponding frequency in US children in general. We also sought to identify predictors of chronic school absenteeism in children with CKD. Design/Methods: We analyzed baseline data obtained from the Chronic Kidney Disease in Children cohort study (CKiD). Participants included in this analysis had mild to moderate CKD and were >5 years of age at study enrollment (N=608). The outcome of interest was chronic school absenteeism, defined as ≥18 missed school days in the last year. The proportion of children with CKD and chronic school absenteeism was compared to published National Health and Nutrition Examination Survey (NHANES) data. To evaluate which clinical and demographic factors were associated with chronic school absenteeism among children with CKD, relative risks (RR) and 95% confidence intervals were estimated with Mantel-Haenszel adjustment for confounders. Results: The overall prevalence of chronic school absenteeism among children with CKD was 17.3%, compared to 2.7% in the NHANES population (RR = 6.2, 95% CI: 4.6-8.4). A variety of demographic, socioeconomic and CKD specific factors were associated with chronic school absenteeism, including glomerular disease, bladder catheterization and acute illnesses. In addition, a higher medication burden was strongly associated with a stepwise increase in risk of chronic school absenteeism. Compared to children taking 1-4 medications, those taking 5-9 medications were 2.3 times more likely to be chronically absent. The relative risk was increased to 4.2 for those taking ≥10 medications. The relationship between medication burden and absenteeism was not confounded by CKD stage. Conclusions: Children with CKD have a high prevalence of chronic school absenteeism, which is likely affecting their academic achievement. Some predisposing factors, such as medication burden, are potentially modifiable and warrant further study. Identifying patient characteristics associated with chronic school absenteeism potentially could allow for early detection and ultimately intervention to improve academic success among children with CKD.