0, as it is specific for children and adolescents with CKD, and is probably more sensitive to detect possible alterations in the health of these patients. In addition, the authors did not find studies in the literature associated to better QoL as perceived Lumacaftor research buy by parents of children and adolescents with CKD that had used the PedsQLTM. In this study, the mean final QoL score perceived by the children was 50.9, a significantly lower result when compared to those recorded by Goldestein et al.,7 in a study performed in the United States (72.5), and by Park et al.,8 in Korea (69.4). The lower score in the present study may be due to the fact that the evaluated children had low

socioeconomic status. A better QoL in renal transplant patients compared to those on hemodialysis in the present study was also reported in a study conducted in Korea involving 92 children with CKD.8 Another study in Texas with 186 children and adolescents with CKD demonstrated that, in addition to better QoL, children submitted to renal transplantation had improved survival. This fact is justified by the authors for the high risk of complications in patients undergoing peritoneal CFTR activator dialysis and hemodialysis.5 Higher scoring in the final QoL score as perceived by male children and adolescents was also demonstrated for the perception of adolescents aged 15 to 18 years with CKD in a study by Maxwell et al.25 Better

scoring in the final QoL score according to the perception of children that practiced physical activity was also observed by other authors. Akber et al.26 evaluated the level of physical activity through the use of pedometers in patients

aged 7 to 20 years with CKD and observed that low levels of physical activity in this age group were associated with higher cardiovascular risks. The researchers also stated that low levels of physical activity were associated with poorer physical performance and worse self-reported QoL.26 Patients with CKD may have muscle dysfunction due to interrelated factors, such as decreased protein-calorie intake, muscle disuse atrophy, and protein imbalance. These factors Sucrase lead to changes in type II muscle fibers and reduction of the capillary vascular bed, intravascular presence of calcification, and reduction of local blood flow, thus contributing to muscle alterations.27 Discordant data to those of the present study refer to muscle strength. The study by Coelho et al.4 in Minas Gerais, involving 30 children with CKD, found lower values in maximal expiratory pressure. When assessing pulmonary function, a positive correlation was observed between FVC and FEV1 with functional capacity. Children with better vital capacity and FEV values showed better performance at the 6MWT, suggesting the influence of these variables on the test. In children with CKD, a decrease in spirometric variables is related to reversible airway obstruction and air trapping caused by accumulation of fluid near the small airways.