Table 2.

Determinants of health-related quality of life (HRQoL) and proposed interventions to improve HRQoL in the pediatric end-stage renal disease (ESRD) population

Determinants	Association with HRQoL	Proposed interventions
Medical factors
Being on dialysis (independent of dialysis modality)	Patients on dialysis reported worse HRQoL scores compared with patients with a functioning transplant. No difference was found between patients on hemodialysis and on peritoneal dialysis	The possibilities of home HD and nocturnal hospital HD should be actively explored
Cosmetic side effects of immunosuppressive therapy	Weight gain, gingiva hypertrophy, acne, and cushingoid appearance are important but underestimated problems in patients with a functioning renal transplant	Managing changes in appearance by learning cosmetic application techniques and combating weight gain through physical exercise are warranted
Stunted height	Shorter patients reported lower self-esteem and satisfaction with health. In addition, height gain and growth hormone use were associated with increases in physical and social functioning by parent-proxy report	Interventions proven to be effective in preventing growth retardation include recombinant growth hormone therapy and steroid-free immunosuppressive regimens
Anemia	Parents of anemic children reported worse HRQoL for their children and patients reported lower physical functioning	Correction of anemia by administration of erythropoietin and iron preparations may significantly improve long-term health outcomes and corresponding HRQoL.
Sociodemographic factors
Gender	Female patients indicated they struggled more emotionally (regardless of length of time on dialysis) and had more concerns about appearance being negatively affected by their disease	Pediatric ESRD programs should direct more psychosocial resources and interventions for those particular vulnerable groups of patients and families that may benefit from greater attention
Ethnic background Parental level of education Nonintact household	Children of non-Western origin were at risk for impaired HRQoL on emotional and school functioning Low parental level of education may result in decreased HRQoL in their children Both patients and parents of nonintact households reported lower emotional HRQoL than samples from married households
Psychosocial factors
Coping strategies Contact with fellow patients	Obtaining knowledge, achieving a sense of normality, autonomy, and empowerment in treatment are important themes for finding ways to incorporate the disease into daily life Contact with fellow patients is important to allow children to share their feelings, coping strategies, and personal questions	Health care providers should acknowledge the specific information needs of particular adolescent patients with ESRD An interdisciplinary and coordinated plan of care that includes self-management strategies, psychosocial programs, and peer sessions facilitated by a social worker or psychologists is called for Self-management, information provision, and contact with fellow patients could possibly be delivered through innovative online initiatives

HD hemodialysis