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Kidney Disease Research Updates
Winter 2011

Children with Kidney Disease Not Getting Enough Sleep

Boy yawning. The boy, who appears to be between 12 and 15 years old, is sitting behind an open book with his open hand pressed against his cheek.

Children with chronic kidney disease (CKD) suffer from difficulty sleeping, weakness, fatigue, and daytime sleepiness, according to the National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK’s) Chronic Kidney Disease in Children (CKiD) study. The largest prospective cohort study of CKD in North American youth, CKiD is assessing how kidney disease affects children’s health and development. The 57-center study is following the health and kidney disease progression of about 500 children, ages 1 to 16 years old.

“Unlike adults who have completed their physiologic and intellectual maturation, children are in formative stages of development and therefore are particularly vulnerable to the adverse effects of CKD and sleep deprivation,” wrote Maria-Eleni Roumelioti, M.D., and co-authors in their February 2010 American Journal of Kidney Diseases report. Roumelioti is a former postdoctoral associate at the University of Pittsburgh Medical Center’s Renal-Electrolyte Division.

Whereas adult CKD is frequently a consequence of hypertension or diabetes, CKD in children is more often due to a primary urologic problem such as a birth defect or a hereditary condition such as polycystic kidney disease. And because they are growing, children with CKD have unique health challenges and care requirements.

CKiD researchers looked at the relationship between measured glomerular filtration rate (mGFR)—a direct measure of the kidneys’ blood filtering capacity—and the incidence and severity of sleep disturbances and fatigue as reported in a survey given to study children and their parents. The survey asked, among other things, if children had difficulty falling asleep at night, woke up too early, or fell asleep inadvertently during the day. The survey also asked about problems with low energy and weakness.

Almost 30 percent of children in the study reported “often” or “almost always” having trouble sleeping or low energy. Impaired mGFR was associated with self-reported weakness and falling asleep during the day. Children who had low birth weight or CKD for longer than 25 percent of their life were more likely to suffer from severe weakness, compared with children who had normal birth weight or CKD for less than 25 percent of their life. Fatigue—low energy and severe weakness—was strongly associated with decreased health-related quality of life (HRQOL). But HRQOL was not affected by waking up early, falling asleep during the day, or decreased alertness.

“Early detection and aggressive management of sleep problems and daytime fatigue have the potential to markedly improve functional outcomes and HRQOL in young patients with chronic kidney disease,” wrote Roumelioti and co-authors, who suggest the study’s findings will help guide those who care for children with CKD.

For NIDDK materials about kidney disease in children, visit


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NIH Publication No. 11–4531
January 2011


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