57 - Pharmacological Treatment of Mental Health Disorders Within the Chronic Kidney Disease in Children Cohort

Poster Number: 57
Publication Number: 57.35

Ryan C. Ward, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Tiffin, IA, United States; Amy Kogon, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Matthew B. Matheson, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Brad A. Warady, Children's Mercy, Kansas City, MO, United States; Susan L. Furth, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Stephen R. Hooper, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Lyndsay Harshman, University of Iowa, Iowa City, IA, United States

Background: The prevalence of mental health disorders (MHD) within the pediatric chronic kidney disease (CKD) population has been well documented. 7% of patients in the Chronic Kidney Disease in Children (CKiD) prospective cohort historically meet survey-based criteria for depression and/or have received treatment for depression. Additionally, 11% within the CKiD cohort have a family-reported ADHD diagnosis. However, there is a gap in our understanding of the pharmacologic agents (PAs) used to treat MHD in this population and patient-related characteristics among those receiving PAs.

Objective: Data from the CKiD prospective cohort study were utilized to describe the use of MHD-associated PAs and patient-related characteristics of use.

Design/Methods: Data from routine CKiD study visits were utilized for analyses. PAs were categorized into four groups: anti-depressants, CNS stimulants, anti-psychotic/mood stabilizing medications, and “other” (e.g., guanfacine, buspirone). Participant age, sex, CKD severity, and duration of PAs use were ascertained. PAs use was evaluated in parallel with CKD disease type and presence of urological comorbidity. Chi-square tests compared PAs use (“ever use”) among these subgroups.

Results: Among 1074 CKiD participants, 6% (n=61) of participants used PAs at study entry (baseline) with 11% reporting incident use of any PAs category (n=120). The most prescribed PAs group at study entry was CNS stimulants. Antidepressants were more frequently reported among incident users. Use of two or more PAs was rare in the cohort (4.6%). For incident users, median eGFR at PAs initiation was 46 ml/min|1.73m². Both CNS stimulants and “other” PAs were more commonly reported in males compared to females (p< 0.005). Antidepressants had the greatest median years to discontinuation (2.1 years), whereas antipsychotics had the fewest (1.1 years).

Conclusion(s): Up to 11% of patients in the CKiD cohort report incident use of any PAs for MHD during study participation with 7% reporting incident use of antidepressants. In contrast, up to 20% of children general pediatrics literature endorse usage of antidepressants. Given reports of ~15-20% usage in the general pediatrics literature, these findings raise the question of whether MHD/symptoms and associated treatments may be under-reported or under-treated among children with CKD.
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