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Background <p>Chronic kidney disease (CKD) in childhood is associated with multidimensional disease burden extending beyond physiological impairment. While reduced health-related quality of life (HRQoL) has been consistently reported, the clinical interpretability and stratification value of HRQoL measures in pediatric CKD remain insufficiently characterized.</p> Methods <p>In this cross-sectional study, HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) in 47 children with CKD and 46 healthy controls. Group differences were analyzed across domains and total scores. Receiver operating characteristic (ROC) analysis was performed to derive a clinically interpretable cutoff value of PedsQL total score for identifying poor HRQoL. Logistic regression models examined associations between renal function parameters and poor HRQoL within the CKD cohort. A within-CKD risk stratification model incorporating eGFR and blood urea nitrogen (BUN) was constructed.</p> Results <p>Children with CKD demonstrated significantly lower HRQoL across physical, emotional, school, psychosocial, and total domains compared with controls (all <i>p</i> &lt; 0.001). ROC analysis was performed to derive a clinically interpretable threshold for impaired HRQoL based on the PedsQL total score, yielding an optimal cutoff value of ≤ 85.8 (AUC 0.826; 95% CI 0.734–0.907) with 70.2% sensitivity and 89.1% specificity. Within the CKD cohort, lower eGFR and higher BUN remained independently associated with poor HRQoL in multivariable analysis. The within-CKD risk model incorporating eGFR and BUN demonstrated moderate discriminatory performance (AUC 0.728) for identifying high-burden patients.</p> Conclusions <p>Children with CKD experience clinically meaningful HRQoL impairment, particularly in advanced disease stages. Objective renal function parameters not only correlate with but moderately discriminate high-burden patients within the CKD population. Integration of structured HRQoL assessment into routine pediatric nephrology care may enhance patient-centered risk stratification.</p> Graphical abstract <p></p>

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Health-related quality of life in children with chronic kidney disease: clinical predictors and ROC-derived thresholds for impaired HRQoL

  • 期刊论文

  • 发表日期：

    2026年8月4日

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  • Abdullah Erol,
  • Mehmet Bülbül,
  • Evrim Kargın Çakıcı

摘要

Background

Chronic kidney disease (CKD) in childhood is associated with multidimensional disease burden extending beyond physiological impairment. While reduced health-related quality of life (HRQoL) has been consistently reported, the clinical interpretability and stratification value of HRQoL measures in pediatric CKD remain insufficiently characterized.

Methods

In this cross-sectional study, HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) in 47 children with CKD and 46 healthy controls. Group differences were analyzed across domains and total scores. Receiver operating characteristic (ROC) analysis was performed to derive a clinically interpretable cutoff value of PedsQL total score for identifying poor HRQoL. Logistic regression models examined associations between renal function parameters and poor HRQoL within the CKD cohort. A within-CKD risk stratification model incorporating eGFR and blood urea nitrogen (BUN) was constructed.

Results

Children with CKD demonstrated significantly lower HRQoL across physical, emotional, school, psychosocial, and total domains compared with controls (all p < 0.001). ROC analysis was performed to derive a clinically interpretable threshold for impaired HRQoL based on the PedsQL total score, yielding an optimal cutoff value of ≤ 85.8 (AUC 0.826; 95% CI 0.734–0.907) with 70.2% sensitivity and 89.1% specificity. Within the CKD cohort, lower eGFR and higher BUN remained independently associated with poor HRQoL in multivariable analysis. The within-CKD risk model incorporating eGFR and BUN demonstrated moderate discriminatory performance (AUC 0.728) for identifying high-burden patients.

Conclusions

Children with CKD experience clinically meaningful HRQoL impairment, particularly in advanced disease stages. Objective renal function parameters not only correlate with but moderately discriminate high-burden patients within the CKD population. Integration of structured HRQoL assessment into routine pediatric nephrology care may enhance patient-centered risk stratification.

Graphical abstract