Psychological impact of chronic kidney disease on children

Abstract

A large number of children are suffering from chronic diseases. Like most chronic childhood illnesses, chronic kidney disease (CKD) deeply affects child's life, both physically and emotionally, concerning that they experience a lot of stress, have many responsibilities with disease management, face possibility of the shortened life span and questionable quality of life. Moreover, CKD would affect the family and siblings too. Many factors influence on proper psychosocial adjustment. Most often it depends on age of the disease’s onset, clinical features, family structure and functioning, child’s age and personality, supporting system etc. Majority of the children with CKD will easily express physical unease, but many of them will hide how they mentally feel. As well as medical treatment, psychological coping and recovery is an important part of managing CKD too. Fear and anxiety are most common emotions. They address health, future, medical procedures especially dialysis or kidney transplantation, uncertainty in the family, school and social life. Depressive feelings, hopelessness or despair can also seriously interrupt the medical treatment and overall child’s health. Denial is present especially when the trauma is very severe and threatens child’s wellbeing. Anger is also common. Child can be mad about what is happening to him/her, mad at parents and medical community for allowing their health to deteriorate, mad to “higher powers” or destiny. Furthermore, impairment of cognitive functions occurs frequently in CKD too. It can be seen in the areas of attention, cognitive flexibility, executive functioning, memory and learning, which can deeply affect child’s everyday functioning or performance in school. Treating children with CKD needs a multidisciplinary care. Early identification and treatment of psychological conditions is very important, in order to improve child’s quality of life as well as his/her family. Children with CKD live longer, so understanding long-term psychosocial effects becomes increasingly important to clinicians and families.