Impact of steroids and steroid-sparing agents on quality of life in children with nephrotic syndrome

• Published in: Pediatric nephrology (Berlin, West) Vol. 36; no. 1; pp. 93 - 102
• Main Authors: Khullar, Shawn, Banh, Tonny, Vasilevska-Ristovska, Jovanka, Chanchlani, Rahul, Brooke, Josefina, Licht, Christoph P. B., Reddon, Michele, Radhakrishnan, Seetha, Piekut, Monica, Langlois, Valerie, Aitken-Menezes, Kim, Pearl, Rachel J., Hebert, Diane, Noone, Damien, Parekh, Rulan S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2021; Springer; Springer Nature B.V
• Subjects: Children; Drug therapy; Fatigue; Health aspects; Kidney diseases; Medicine; Medicine & Public Health; Nephrology; Nephrotic syndrome; Original Article; Patient outcomes; Pediatric research; Pediatrics; Quality of life; Steroid hormones; Steroids; Steroids (Drugs); Urology; Canada; PedsQL (pediatric quality of life inventory); Corticosteroids; HRQOL (health-related quality of life); Steroid-sparing medications
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-020-04684-3

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.