Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CKD”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed2006

Traditional and emerging cardiovascular and renal risk factors: an epidemiologic perspective.

Patients with chronic kidney disease (CKD) represent an important segment of the population (7-10%) and, mostly because of the high risk of cardiovascular complications associated with renal insufficiency, detection and treatment of CKD is now a public health priority. Traditional risk factors can incite renal dysfunction and cardiovascular damage as well. As renal function deteriorates, non-traditional risk factors play an increasing role both in glomerular filtration rate (GFR) loss and cardiovascular damage. Secondary analyses of controlled clinical trials suggest that inflammation may be a modifiable risk factor both for cardiac ischemia and renal disease progression in patients with or at risk of coronary heart disease. Homocysteine predicts renal function loss in the general population and cardiovascular events in end-stage renal disease (ESRD), but evidence that this sulfur amino acid is directly implicated in the progression of renal disease and in the high cardiovascular mortality of uremic patients is still lacking. High sympathetic activity and raised plasma concentration of asymmetric dimethylarginine (ADMA) have been associated to reduced GFR in patients with CKD and to cardiovascular complications in those with ESRD but again we still lack clinical trials targeting these risk factors. Presently, the clinical management of CKD patients remains largely unsatisfactory because only a minority of these attain the treatment goals recommended by current guidelines. Thus, in addition to research into new and established risk factors, it is important that nephrologists make the best use of knowledge already available to optimize the follow-up of these patients.

Cardiovascular Diseases↗
PubMed2006

Sarcoid tubulo-interstitial nephritis: long-term outcome and response to corticosteroid therapy.

Sarcoidosis is a chronic relapsing multi-systemic disorder characterized by the development of non-caseating granulomas. Granulomatous tubulo-interstitial nephritis is an uncommon manifestation of this condition. We identified 39 patients with sarcoidosis and renal disease from a single center of whom 17 patients had biopsy-proven tubulo-interstitial nephritis. They were analyzed with respect to demographic and clinical features, including response to corticosteroids and length of follow-up. They all presented with significant renal impairment. At presentation the mean+/-s.d. estimated glomerular filtration rate (eGFR) was 26.8+/-14 ml/min by modification of diet in renal disease (MDRD) equation 7. With treatment there was a significant improvement in renal function with eGFR 49.6+/-5.2 ml/min (P<0.01) at 1 year, and 47.9+/-6.8 ml/min (P<0.05) at the last review. The median follow-up was 84 months (range 6-284 months). Patients with chronic kidney disease (CKD) 3, the mean eGFR was 38.30+/-2.4 ml/min at presentation and 60.2+/-7.4 ml/min at 1 year (P=0.02) and in CKD 4 it improved from 19+/-2 to 38+/-6.6 ml/min at 1 year (P<0.05). After the 1st year, the change in eGFR was +0.8 ml/min/year for CKD 3 and -2 ml/min/year for CKD 4 (P<0.05). Three patients ceased their therapy either due to complications or poor compliance and experienced a worsening of renal function which was then reversed on re-commencing corticosteroids. Corticosteroids are effective in advanced tubulo-interstitial nephritis due to sarcoidosis. Long-term treatment is necessary to preserve renal function and to delay the onset of end-stage renal disease.

Adrenal Cortex Hormones↗
PubMed2006

Lead-related nephrotoxicity: a review of the epidemiologic evidence.

Chronic kidney disease (CKD) represents a major global public health concern. Efforts to prevent and/or slow progression of CKD are essential. Lead nephropathy, characterized by chronic tubulointerstitial nephritis, is a well-known risk of chronic, high-level lead exposure. However, in recent years, lead exposure has declined sharply, particularly in developed countries. We reviewed epidemiologic research in general, occupational, and patient populations to assess whether lead, at current exposure levels, still contributes to nephrotoxicity. Other pertinent topics, such as risk in children, genetic susceptibility, and co-exposure to cadmium, are also considered. The data reviewed indicate that lead contributes to nephrotoxicity, even at blood lead levels below 5 microg/dl. This is particularly true in susceptible populations, such as those with hypertension (HTN), diabetes, and/or CKD. Low socioeconomic status is a risk factor for both lead exposure and diseases that increase susceptibility. Future public health risk for lead-related nephrotoxicity may be most significant in those rapidly developing countries where risk factors for CKD, including obesity and secondary HTN and diabetes mellitus, are increasing more rapidly than lead exposure is declining. Global efforts to reduce lead exposure remain important. Research is also needed to determine whether specific therapies, such as chelation, are beneficial in susceptible populations.

Humans↗
PubMed2006

Calcitonin concentrations in patients with chronic kidney disease and medullary thyroid carcinoma or c-cell hyperplasia.

It is currently not known which level of pentagastrin-stimulated calcitonin serum concentration indicates medullary thyroid carcinoma in patients with chronic kidney disease (CKD). We examined CKD stage 3-5 patients who had total thyroidectomy because of a pentagastrin-stimulated calcitonin concentration greater than 100 pg/ml, and tested the diagnostic performance of basal and pentagastrin-stimulated calcitonin levels for differentiating medullary thyroid carcinoma and C-cell hyperplasia in this patient population. A total of 180 CKD patients presented with an elevated calcitonin level and had a pentagastrin stimulation test. Forty patients showed a maximum pentagastrin-stimulated calcitonin concentration greater than 100 pg/ml, and 22 patients had a total thyroidectomy. Seven of these 22 patients presented with a medullary thyroid carcinoma, all other patients showed C-cell hyperplasia. Patients with medullary thyroid carcinoma showed higher unstimulated (212 pg/ml (36-577) vs 42 pg/ml (17-150); P < 0.001) and higher maximum pentagastrin-stimulated calcitonin concentrations (862 pg/ml (431-2423) vs 141 pg/ml (102-471); P < 0.001) as compared to patients with C-cell hyperplasia. The sensitivity (100%) and specificity (93%) estimates suggested that a maximum pentagastrin-stimulated calcitonin concentration greater than 400 pg/ml indicates the presence of medullary thyroid carcinoma in patients with CKD. Receiver-operating characteristic (ROC) analysis revealed an area under the ROC plot of 0.99 for maximum pentagastrin-stimulated calcitonin concentrations. A maximum pentagastrin-stimulated calcitonin concentration greater than 400 pg/ml appears to be a clinically meaningful threshold for thyroidectomy.

Adolescent↗
PubMed2002

Opportunities to improve the care of patients with kidney transplant failure.

BACKGROUND: Patients initiating dialysis after a failed kidney transplant are a subgroup of chronic kidney disease (CKD) patients who have not been characterized. Exposure to immunosuppressive medications differentiates these patients from the general incident end-stage renal disease (ESRD) population. METHODS: Data from the Health Care Financing Administration 2728 form were used to determine the hematocrit, erythropoietin use, serum albumin and glomerular filtration rate (GFR) among 4643 patients with failed kidney transplants who initiated dialysis between April 1995 and December 1998. RESULTS: At dialysis initiation, the mean hematocrit, serum albumin and GFR were 27.5%, 3.3 g/dL, and 8.4 mL/min/1.73 m2, respectively, and only 35% of patients had received erythropoietin. In a multivariate analysis, patients <45 years, females, patients of non-White race, non-diabetic patients, hemodialysis patients and patients with a lower serum albumin had a higher odds for hematocrit <30%. Erythropoietin use was associated with female gender, White race, increased time since transplantation, being employed, peritoneal dialysis, and higher serum albumin. Patients >/=45 years and patients with diabetes or congestive heart failure had higher odds for hypoalbuminemia, while employed patients, peritoneal dialysis patients, patients with higher hematocrit and patients who had received erythropoietin had lower odds of hypoalbuminemia. CONCLUSIONS: Despite being known to specialty physicians, patients with failed kidney transplants initiate dialysis at levels of hematocrit, serum albumin, and GFR that may be suboptimal and similar to those in the general incident ESRD population. Socioeconomic factors remain important barriers to the provision of CKD care even among these patients with established specialty physician contact. Improved CKD care could improve the outcomes of this unique subgroup of CKD patients.

Adult↗
PubMed2002

What should the optimal target hemoglobin be?

Partial correction of anemia in patients with chronic kidney disease (CKD) improves anemia-related symptoms. However, controversy remains as to whether total correction of anemia provides benefits over and above those afforded by partial correction. There is some evidence showing that normalization of hemoglobin (Hb) concentrations may improve the cardiac hyperdynamic state in CKD patients and reduce the diameter of the left ventricle. Further studies have shown that normalization of Hb improves cognitive function and physical capacities as measured by quality of life (QoL) tests. Large studies have shown that in dialysis patients there is a close inverse relationship between hematocrit (Hct) levels and mortality and morbidity. Moreover, there is evidence suggesting that Hct levels higher than those recommended by European Best Practice Guidelines (EBPG) and the National Kidney Foundation Dialysis Outcome and Quality Initiative (NKF-DOQI provide better outcomes for patients with CKD. However, when Hb concentrations are increased to normal in selected patients with cardiac disease, congestive heart failure, or ischemic cardiopathy, higher mortality rates are evident. Therefore, while the majority of patients with CKD may experience significant benefits when Hb is normalized, it seems prudent to recommend individualized target Hb concentrations for each patient, taking into account factors such as age, sex, employment status, physical activity, and co-morbidities.

Anemia↗
PubMed2003

The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease.

BACKGROUND: Provision of adequate iron to support erythropoiesis in patients with chronic kidney disease (CKD) is time consuming and may present adherence problems for patients in the outpatient setting. We studied an accelerated regimen of high-dose intravenous iron sucrose therapy in a cohort of iron-deficient, anemic CKD patients. METHODS: Intravenous iron sucrose 500 mg was infused over three hours on two consecutive days in 107 CKD patients (glomerular filtration rate, 32.3 +/- 19.6 mL/min/1.73m2, baseline hemoglobin 10.2 +/- 1.7 g/dL). Iron indices (transferrin saturation, ferritin) were measured at baseline and at two and seven days after completion of the iron regimen. Blood pressures were monitored immediately prior to, and hourly throughout the iron sucrose infusions. RESULTS: Transferrin saturation and serum ferritin increased from 18.5 +/- 8.5% and 177 +/- 123.8 ng/mL at baseline to 40.2 +/- 22.3% and 811 +/- 294.1 ng/mL in 102 evaluated patients (P < 0.015). In 55 patients with additional measurements at 7 days post-dosing, the transferrin saturation and ferritin had fallen to 26.3 +/- 10.6% and 691 +/- 261.8 ng/mL (P < 0.015 compared to two days' post-dose). Blood pressure rose slightly, but not significantly, throughout the infusions, and altering the infusion rate was not necessary. Two patients had seven adverse events that were considered related to iron sucrose. CONCLUSION: An accelerated regimen of high-dose intravenous iron sucrose therapy in CKD patients is safe and effective in restoring iron stores, and may potentially save time and improve patient adherence.

Aged↗
PubMedDate not supplied

Traditional cardiac risk factors in individuals with chronic kidney disease.

Individuals with chronic kidney disease (CKD) are at increased risk for the development and progression of cardiovascular disease (CVD). The increased risk is due to a higher prevalence of both traditional risk factors as well as nontraditional risk factors. In this review we focus on individuals at all stages of CKD and discuss modifiable traditional risk factors, namely hypertension, dyslipidemia, diabetes mellitus and poor glycemic control, smoking, and physical inactivity. The prevalence of each risk factor and its relationship with CVD is described. Treatment recommendations are provided using evidence available from populations with CKD or evidence extrapolated from the general population when there are insufficient data on individuals with CKD.

Cardiovascular Diseases↗
PubMedDate not supplied

Dialysis in pregnant women with chronic kidney disease.

Pregnancy occurs uncommonly in women with chronic kidney disease (CKD) and fetal outcome tends to be poor, with high rates of prematurity and mortality. Dialysis, by complementing residual renal function, may improve fetal outcome in pregnant women with CKD. Although there are no prospective or randomized trials that examine the relationship between dialysis and fetal outcome, there is evidence that increased solute clearance, by early initiation of or intensification of dialysis, is beneficial for the health of the fetus. Case reports and observational studies from the United States, Belgium, and Saudi Arabia suggest that there is a relationship between successful pregnancy and the amount of dialysis received. Unfortunately, in these reports, measures of residual renal function and dialysis adequacy are lacking or incomplete. Nonetheless, compared to nonpregnant patients with CKD, in pregnant women with CKD it is reasonable to begin dialysis at a higher level of residual renal function in the hope of improving fetal outcome.

Female↗
PubMed2001

Determinants of delayed nephrologist referral in patients with chronic kidney disease.

Late referral to nephrologists of patients with chronic kidney disease (CKD) is a major public health problem because it is prevalent and associated with increased morbidity, mortality, and greater healthcare costs. To identify factors associated with delayed nephrologist referral (first nephrologist visit < 90 days before the onset of renal replacement therapy), we identified a cohort of patients with preexisting CKD that progressed to end-stage renal failure. We developed a logistic regression model to measure the association of specific demographic and clinical covariates with delayed nephrologist referral. Delayed referral was highly associated with older age (P < 0.001), race other than white or black (P = 0.002), and the absence of certain comorbidities: hypertension (P < 0.001), coronary artery disease (P < 0.001), malignancy (P = 0.005), and diabetes (P = 0.02). Associations of late referral with male sex (P = 0.07) and lower socioeconomic status (P = 0.09) were of borderline significance. Patients who were predominantly cared for by a general internist were more likely to be referred late to a nephrologist compared with those cared for by a family or primary care practitioner (P = 0.002) or another subspecialist (P = 0.019). These findings suggest that several factors increase the risk that patients with CKD will have the first nephrologist consultation excessively late in the course of their disease. Although timely access to nephrologist services is important for all patients with advanced CKD, this is of particular concern in older patients, those in certain minority populations, and those in whom the absence of comorbidity may provide a false sense of true risk status.

Age Distribution↗
PubMed2002

Health care resource utilization and the impact of anemia management in patients with chronic kidney disease.

BACKGROUND: Limited information exists on resource utilization patterns and overall patient management of chronic kidney disease (CKD) before the initiation of dialysis therapy. METHODS: A retrospective claims analysis from January 1997 to December 1999 was conducted using a managed care database on 1,936 incident dialysis patients, examining the 12 months preceding dialysis initiation to evaluate whether managed care patients with CKD are receiving expected interventions and appropriate management of CKD. RESULTS: Mean age was 66.8 years, 46% were women, 91.2% had claims for facility services, 97.6% had claims for professional services, and 95.7% had claims for outpatient pharmacy, with mean costs per patient of $26,204, $9,623, and $1,503, respectively. Sixty-two percent of patients were hospitalized, averaging 1.3 admissions annually ($14,818/admission; average, 7.8 d/admission). Despite high overall resource use, treatments for preparation for dialysis therapy, appropriate tests, and nutritional supplements (eg, phosphate binders, B-complex combinations, and vitamins with iron) were administered infrequently. Comorbid conditions, such as anemia (47.4%) and diabetes (53%), were appropriately addressed with erythropoietin (10.5%) and angiotensin-converting enzyme inhibitors (38%) in only a minority of cases. In preparation for dialysis therapy, only 20.8% underwent a vascular access procedure. CONCLUSION: Although patients consumed significant amounts of resources during the 12 months before dialysis initiation, many were not using expected resources for the appropriate management of CKD. A number of opportunities exist to improve predialysis care through better management of these conditions.

Aged↗
PubMed2002

Safety and efficacy of sodium ferric gluconate complex in patients with chronic kidney disease.

BACKGROUND: We hypothesized that intravenous iron will improve hemoglobin (Hgb) concentrations in anemic patients with chronic kidney disease (CKD), and the response would be greater if the underlying erythropoietin deficiency also was treated. METHODS: Charts of 58 CKD veterans (glomerular filtration rate < 80 mL/min) administered at least 125 mg of sodium ferric gluconate complex in sucrose (SFGC) during a period of 1 year for the primary outcome of an increase in Hgb level by at least 0.5 g/dL were reviewed. RESULTS: Mean Hgb level at baseline was 10.5 +/- 1.4 (SD) g/dL (105 +/- 14 g/L) in the 30 patients administered recombinant human erythropoietin (rHuEPO) plus SFGC and 10.1 +/- 1.3 g/dL (101 +/- 13 g/L) in the 28 patients administered SFGC alone (P = not significant). The primary event occurred in 83% of the rHuEPO-plus-SFGC group at 31 days compared with 60% at 62 days in the group administered SFGC alone (P = 0.037, Cox F test). In patients administered SFGC alone, mean maximal Hgb level was 11.4 +/- 0.9 g/dL (114 +/- 9 g/L) in contrast to 12.4 +/- 1.7 g/dL (124 +/- 17 g/L) in the combination group, which remained significantly different even after adjustment for biologically important covariates (P = 0.01, analysis of covariance). Of the 240 doses of SFGC administered for which infusion records were available, 237 doses were well tolerated; three hypotensive episodes occurred in 2 patients, which did not result in discontinuation of the drug in either case. CONCLUSION: Correction of anemia with parenteral iron alone suggests a high prevalence of iron deficiency in patients with CKD. Treatment of concomitant iron deficiency with SFGC was well tolerated in patients with CKD and appears to optimize management of anemia.

Administration, Oral↗
PubMed2003

Chronic kidney disease as a risk factor for bleeding complications after coronary artery bypass surgery.

BACKGROUND: The aim of the study is to define the role of chronic kidney disease (CKD) as a risk factor for postoperative bleeding in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: This is a retrospective cohort study of 238 consecutive patients who underwent isolated CABG surgery. Patients were followed up for the event of a significant bleed, defined as administration of either three or greater units of packed red blood cells, three or greater units of platelets, three or greater units of fresh frozen plasma, or any cryoprecipitate within 72 hours after a CABG procedure or undergoing a surgical revision for bleeding. Glomerular filtration rate (GFR) at baseline was calculated using the Cockroft-Gault formula. A final multiple logistic regression model was selected from a large set of presurgical and intraoperative covariates by using backward elimination (P > 0.20). RESULTS: After controlling for age, sex, elective versus emergent surgery, intraoperative activated clotting time, serum albumin level, extracorporeal bypass time, and baseline hematocrit, we found that even mild levels of renal impairment were associated with increased risk for postoperative bleeding: patients with a GFR of 40 mL/min or less had six times the odds of postoperative bleeding than patients with a GFR greater than 100 mL/min (odds ratio [OR], 6.51; 95% confidence interval [CI], 1.87 to 22.66); those with a GFR of 41 to 60 mL/min had nearly four times the risk (OR, 3.87; 95% CI, 1.21 to 12.35). Even patients with mild CKD at a GFR of 61 to 80 mL/min were at an elevated risk (OR, 2.11); however, the 95% CI of 0.79 to 5.64 included the null value. Similar results were found when using the cruder Kidney Disease Outcomes Quality Initiative classification of CKD. CONCLUSION: CKD is associated with risk for postoperative bleeding in patients undergoing CABG surgery, not only at more advanced stages, but probably at relatively mild levels of renal impairment, as well.

Aged↗
PubMed2006

Association of kidney function with mortality in patients with chronic kidney disease not yet on dialysis: a historical prospective cohort study.

Significant mortality occurs in populations with chronic kidney disease (CKD), but the relative contributions of lower glomerular filtration rate (GFR) itself, accompanying comorbidities, and the numerous abnormalities that develop with advancing CKD are poorly studied. We examined all-cause predialysis mortality in 861 United States veterans with CKD stage 3 to 5 not yet on dialysis. The association of GFR with mortality was analyzed by the Kaplan-Meier method, and the effects of several confounding variables on mortality were assessed in a Cox proportional-hazards model. Overall death rate was 102.1/1,000 person-years (95% CI: 90.2 to 115.6). Lower kidney function was associated with higher mortality (relative risk [95%CI] for GFR less than 20 v 41 to 60 mL/min/1.73 m2: 2.56 [1.61 to 4.07], P<0.001) after adjustment for age, race, diabetes mellitus, cardiovascular disease, smoking status, body mass index, mean arterial pressure, serum albumin, blood cholesterol, haemoglobin, and 24-hour urine protein. For every 10 mL/min/1.73 m2 lower estimated GFR, the adjusted relative risk of mortality (95% CI) was 1.28 (1.12 to 1.45), P<0.001. Lower kidney function is associated with increased mortality in patients with moderate and advanced CKD. This association is present even after adjustment for several confounders.

Aged↗
PubMed2006

Overview of vaccination in chronic kidney disease.

Infections are a major cause of death in end-stage renal disease (ESRD) patients, second only to cardiovascular disease, and also contribute to significant morbidity in patients with earlier stages of chronic kidney disease (CKD). Vaccines are a strategy to attempt to reduce morbidity related to infections. Patients with CKD and ESRD may not respond as well to vaccines as patients without kidney failure, but adequate seroresponse with standard or augmented regimens for vaccinations against influenza, hepatitis B, pneumococcus, and varicella have been documented. Influenza, in particular, seems to provide adequate protection with standard dosing regimens. Despite somewhat reduced effectiveness of certain vaccines in patients with CKD, there is emerging evidence of benefit to vaccination in these populations. However, vaccination rates are relatively low. Given the accumulating evidence of benefit, continuing quality improvement programs focused on increasing vaccination rates in patients with all levels of CKD are needed.

Bacterial Infections↗
PubMed2006

Epidemiology of obesity and chronic kidney disease.

The obesity epidemic has reached nephrology in the form of increasing numbers of patients with chronic kidney disease (CKD) caused by obesity-related metabolic disorders, IgA nephropathy, stone disease, and a unique glomerulopathy now known as obesity-related glomerulopathy (ORG). Obesity has been identified as an independent risk factor for CKD, and patients with central adiposity or high waist-to-hip ratios appear to have the highest risk. The metabolic syndrome is a risk factor for albuminuria and CKD, and studies now show that the risk of CKD increases with increased numbers of components of the metabolic syndrome. Obesity is not just a bystander or accelerator of other kidney diseases, but has unique histopathologic characteristics that can cause progressive kidney disease. ORG may accompany and worsen IgA nephropathy, urate nephropathy, and possibly even diabetic nephropathy. The origins of obesity-related kidney disease can be traced to insufficient glomerular complement from birth, and low birth weight may be an important precursor to obesity and its many comorbidities. Intervention strategies may need to target prenatal care through the elderly to combat this problematic epidemic.

Albuminuria↗
PubMed2007

Management of chronic kidney disease mineral-bone disorder.

Chronic kidney disease mineral-bone disorder (CKD-MBD) is a systemic disorder of abnormal serum levels of mineral-related biochemistries, abnormal bone, and extraskeletal calcification. Although we have gained understanding on how these components are interrelated, our therapeutic tools remain focused on only one aspect of CKD-MBD at a time. However, the management of these disorders is also interrelated; treatments may help one aspect of the disorder but cause or accelerate another. As such, management remains a major challenge to nephrologists and requires balancing risk and benefit of the various available therapies. Our challenge for the decade ahead is to determine which combinations of therapy can be used safely together to prevent morbidity and mortality in CKD. Furthermore, the pathophysiology that sets these events into motion begins well before the onset of ESRD. Future therapies and guidelines should, therefore, also emphasize the need for earlier detection and management of CKD, shaped by the results of valid clinical trials.

Bone Density Conservation Agents↗
PubMed2004

Anemia and health-related quality of life in adolescents with chronic kidney disease.

BACKGROUND: A number of studies of adults with chronic kidney disease (CKD) have shown a negative impact of anemia on several aspects of health-related quality of life (HRQOL). Although similar links have been suggested in adolescent dialysis populations, the relationship between anemia and HRQOL in children not requiring dialysis therapy has yet to be studied extensively in a large sample. METHODS: We examined the association between anemia and HRQOL in baseline data collected on a prospective cohort of adolescents with CKD by using a generic HRQOL questionnaire completed by parents or caregivers (Child Health Questionnaire Parent Form [CHQ-PF50]). Our study population included guardians or caregivers of 105 adolescents (mean age, 14 +/- 2 years) with stages 1 to 5 CKD as defined by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative, including subjects with chronic renal insufficiency, patients with functioning kidney transplants, and dialysis patients. RESULTS: Seventy of 105 patients were classified in the study as anemic according to a hematocrit value of 36% or less. Compared with the group with higher hematocrit values and independent of sex, race, and estimated glomerular filtration rate, anemic patients reported greater limitations in CHQ-PF50 domains relating to (1) physical functioning, (2) limitations in schoolwork or activities with friends as a result of physical health, and (3) parental impact in time and family activities. CONCLUSION: Anemia was associated with lower quality of life in adolescents across the spectrum of stages of CKD. Future studies should address the effect of interventions to improve anemia on HRQOL.

Adolescent↗