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Abstract: PO2006

Associations Between Clean Intermittent Catheterization, Quality of Life, and Emotional-Behavioral Functioning in Children with CKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology


  • Johnson, Rebecca J., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Harshman, Lyndsay, The University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, United States
  • Matheson, Matthew, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Kogon, Amy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Lande, Marc, University of Rochester Medical Center, Rochester, New York, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Hooper, Stephen R., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States

Need for clean intermittent catheterization (CIC) can affect quality of life (QOL) and emotional functioning in pediatric populations, with some evidence that urethral catheterization is associated with poorer emotional adaptation than use of Mitrofanoff. Little is known about the impact of CIC on QOL and emotional functioning for children with chronic kidney disease (CKD).


Data from the CKiD study were used to evaluate QOL, emotions/behavior, and CIC in children age 6+ years with mild to moderate CKD (non-glomerular disease). We hypothesized that CIC would be associated with poorer QOL and more internalizing and behavioral symptoms (using ratings from BASC2, PedsQL), and that urethral CIC (versus Mitrofanoff) would predict worse outcomes. Linear mixed models adjusted for sociodemographic and disease-related covariates were used and included predictors for CIC use (vs non-users) as well as for urethral catheterization (vs Mitrofanoff).


The sample included 1484 records (466 CIC non-users, median age 10 years, 66% male, median eGFR 52 ml/min|1.73m2; 115 CIC users, median age 12 years, 67% male, median eGFR 45, 43% urethral, 48% Mitrofanoff). Median BASC2 scores were in the average range for both CIC users and non-users. Median PedsQL scores were slightly lower than that of healthy populations for CIC non-users (parent-report 80 [IQR=66,89]; child-report 79 [IQR=70,88]) and even lower for CIC users (parent-report 73 [IQR=59,85]; child-report 76 [IQR=65,85]. CIC predicted higher scores on the BASC2 Internalizing Composite (β=3.33, CI=1.13, 5.54; p=.003), and Behavioral Symptoms Index (β=2.13, CI=0.08, 4.18; p=.04), and lower parent- and child-reported QOL (β=-5.11, CI=-8.46, -1.75; p=.003; β=-3.75, CI=-6.98, -0.52; p=.02). However, urethral CIC predicted lower scores compared to Mitrofanoff on the Internalizing Composite (β=-3.94, CI=-6.65, -1.22; p=.005).


For children with mild to moderate CKD, CIC is associated with poorer QOL and more parent-reported emotional-behavioral symptoms. Urethral CIC (versus Mitrofanoff) is associated with fewer internalizing symptoms. Additional research is needed to determine if other characteristics associated with need for CIC influence emotions and QOL.


  • NIDDK Support