Kidney Week

Abstract: TH-PO1218

Psychologic Distress Among Caregivers of Children with CKD and Its Effect on Kidney Failure Treatment Preferences: A Survey Study

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Schnaith, Abigail Marie, Emory University Department of Pediatrics, Atlanta, Georgia, United States

Abigail Marie Schnaith, MD

• Urbanski, Megan, Emory University Department of Surgery, Atlanta, Georgia, United States

Megan Urbanski, PhD, MSW

• Reed, Bonney, Emory University Department of Pediatrics, Atlanta, Georgia, United States

Bonney Reed, PhD

• Huang, Hui, Emory University Department of Biostatistics and Bioinformatics, Atlanta, Georgia, United States

Hui Huang, MS

• Westbrook, Adrianna, Emory University Department of Biostatistics and Bioinformatics, Atlanta, Georgia, United States

Adrianna Westbrook, MPH

• Kennedy, Sabina, Emory University Department of Pediatrics, Atlanta, Georgia, United States

Sabina Kennedy, MD

• Garro, Rouba, Emory University Department of Pediatrics, Atlanta, Georgia, United States

Rouba Garro, MD

• Greenbaum, Larry A., Emory University Department of Pediatrics, Atlanta, Georgia, United States

Larry A. Greenbaum, MD, PhD

• Wang, Chia-Shi, Emory University Department of Pediatrics, Atlanta, Georgia, United States

Chia-Shi Wang, MD, MS

Background

Caregivers of children with CKD make important kidney failure treatment decisions, including dialysis modality and type of kidney transplant. Caregiver psychological distress may be a barrier to pursuing living donation. Little is known about the prevalence of depression, anxiety and stress in caregivers of pediatric patients with CKD and its impact on kidney failure treatment preferences.

Methods

We surveyed caregivers of children (<18y) with pre-transplant CKD III-V at outpatient clinics to assess the presence of depression, anxiety and stress among caregivers using the Depression Anxiety & Stress Scale (DASS-21). Psychologic distress was defined as having ≥1 categories positive. Comparisons across CKD stages were performed using Kruskal–Wallis rank-sum test or Fisher’s exact test. Univariable firth logistic regression was used to examine the association between caregiver psychologic distress with kidney failure treatment preferences and preference confidence (SURE Ottawa Decision Conflict Scales). Open-ended survey responses elicited additional details on psychologic distress.

Results

A total of 57 caregivers completed the survey, 85% approached: 32 CKD, 10 HD, 15 PD. Overall, 50% were positive for psychologic distress: 18 (32%) depression, 23 (41%) anxiety, and 23 (41%) stress which meaningfully impacted their lives (Figure 1). Number of positive psychologic distress domains differed by CKD stage (p = 0.022), with caregivers of children on HD more frequently having two affected domains (60.0%). Forty percent of caregivers selected “I am not sure” for preferred kidney transplant type. Psychologic distress was not statistically associated with preference on kidney transplant type, but stress was associated with increased confidence of treatment preference (OR 3.02, 95% CI 1.02-9.75, p=0.046).

Conclusion

Psychologic distress is common and greatly impacts caregivers of children with CKD III-V. Greater caregiver screening and support is warranted as well as additional investigation into its influence on kidney failure care.

Acknowledgment

Funding received from Children's Healthcare of Atlanta and Emory University Pediatric Biostatistics Core Award and Warshaw Fellows Award.