Duration of chronic kidney disease reduces attention and executive function in pediatric patients

Mendley, Susan R.; Matheson, Matthew B.; Shinnar, Shlomo; Lande, Marc B.; Gerson, Arlene C.; Butler, Robert W.; Warady, Bradley A.; Furth, Susan L.; Hooper, Stephen R.

doi:10.1038/ki.2014.323

Cited by 84 publications

(74 citation statements)

References 45 publications

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“…Other measures of verbal speed/cognitive efficiency and set shifting will need to be examined in relation to elevated BPV in order to support the findings obtained from this study. Nonetheless, our previous work suggests that measures of executive function may be most sensitive to the effects of childhood CKD [25]. We excluded children less than 6 years old.…”

Section: Discussionmentioning

confidence: 99%

Association of blood pressure variability and neurocognition in children with chronic kidney disease

et al. 2016

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Background Children with chronic kidney disease (CKD) and hypertension have increased blood pressure variability (BPV). Increased BPV has been associated with lower neurocognitive test scores in adults. Children with CKD are at risk for decreased neurocognitive function. Our objective was to determine if children with CKD and increased BPV had worse performance on neurocognitive testing compared with children with CKD and lower BPV. Methods This was a cross-sectional and longitudinal analysis of the relation between BPV and neurocognitive test performance in children 6 years and older enrolled in the Chronic Kidney Disease in Children (CKiD) study. Visit-to-visit BPV was assessed by the standard deviation of visit BPs (BPV-SD) and average real variability (ARV). Ambulatory BPV was assessed by SD of wake and sleep periods on 24hr ambulatory BP monitoring. Results 650 subjects had a mean follow-up period of 4.0 years. Subjects with systolic visit-to-visit BPV in the upper tertile had lower scores on Delis–Kaplan Executive Function System (D-KEFS) Verbal Category Switching than those with BPV in the lower tertile (BPV-SD, 8.3 vs. 9.5, p = 0.006; ARV, 8.5 vs. 9.6, p = 0.02). On multivariate analysis, the association between lower Category Switching score and increased BPV remained significant after controlling for mean BP, demographic characteristics, and disease-related variables (BPV-SD, β = −0.7, 95% confidence interval [CI]: −1.28 to −0.12; ARV, CI: −1.05 to −0.02). Ambulatory BPV was not independently associated with any cognitive measure. Conclusions Higher systolic visit-to-visit BPV was independently associated with decreased D-KEFS Category Switching scores in children with mild-to-moderate CKD.

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Section: Discussionmentioning

confidence: 99%

Association of blood pressure variability and neurocognition in children with chronic kidney disease

et al. 2016

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“…Based on factors found to be associated with other neuropsychological measures in prior CKiD studies 21,22,29 we also collected data regarding age, sex, race, maternal education, etiology of CKD, age at diagnosis, duration of CKD, GFR, urine protein:creatinine ratio, body mass index, height, casual blood pressure measurements, past history of psychiatric disease and current medication use as variables possibly related to depression. For the cross sectional analysis, demographic and medical history information was collected at the baseline study visit.…”

Section: Methodsmentioning

confidence: 99%

Depressive Symptoms in Children with Chronic Kidney Disease

Matheson

Gerson

Hooper

et al. 2016

The Journal of Pediatrics

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Objective To assess depression in children with chronic kidney disease (CKD) and to determine associations with patient characteristics, intellectual and educational levels, and health related quality of life (HRQoL). Study design Subjects aged 6–17 years from the Chronic Kidney Disease in Children cohort study completed the Children’s Depression Inventory (CDI), Wechsler’s Abbreviated Scales of Intelligence, Wechsler Individual Achievement Test-II-Abbreviated, and the Pediatric Inventory of Quality of Life Core Scales 4.0. Regression analyses determined associations of CDI score and depression status with subject characteristics, intellectual and educational levels, and HRQoL. A joint linear mixed model and Weibull model were used to determine the effects of CDI score on longitudinal changes in glomerular filtration rate (GFR) and time to renal replacement therapy. Results 344 subjects completed the CDI. Eighteen (5%) had elevated depressive symptoms and another 7 (2%) were being treated for depression. In adjusted analyses, maternal education beyond high school was associated with 5% lower CDI scores (estimate 0.95; 95% CI 0.92, 0.99). Depression status was associated with lower IQ (99 versus 88, P= 0.053), lower achievement (95 versus 77.5, P<0.05), and lower HRQoL by parent and child reports (effect estimates −15.48; 95% CI −28.71, −2.24 and −18.39; 95% CI −27.81, −8.96, respectively). CDI score was not related to change in GFR. Conclusion Children with depression had lower psychoeducational skills and worse HRQoL. Identifying and treating depression should be evaluated as a means to improve the academic performance and HRQoL of children with CKD.

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“…39 Interestingly, a longitudinal study of patients receiving renal allografts did show that patients with impaired cognitive function prior to transplant improved after transplantation such that post-transplant test scores were not appreciably different from healthy norms. 60 Although we are not including children in this review, we note that the presence of neurocognitive deficits even in children 61, 62 also supports a possible effect of CKD or its sequelae on neurologic function.…”

Section: Cognitive Dysfunctionmentioning

confidence: 99%

Consequences of CKD on Functioning

Kittiskulnam

Sheshadri

Johansen

2016

Seminars in Nephrology

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CKD is highly prevalent in the U.S. and throughout the world,1 with approximately 13% of adults affected.2 In addition, according to recent estimates, almost half of patients with CKD stage 3-5 are 70 years of age or older.2 In the United States, the number of prevalent ESRD cases continues to rise in patients aged over 65. In light of the demographic characteristics of patients with CKD and ESRD, there has been considerable focus on associations between CKD and cardiovascular outcomes.3 Until recently, less attention had been paid to other consequences of CKD in general and among older individuals with CKD in particular, but there is now solid evidence linking CKD with impairments of physical function, cognitive function, and emotional function and quality of life. This review will summarize available literature on these topics, focusing specifically on physical functioning and frailty; cognitive function; emotional health, including depression and anxiety; and health-related quality of life.

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Duration of chronic kidney disease reduces attention and executive function in pediatric patients

Cited by 84 publications

References 45 publications

Association of blood pressure variability and neurocognition in children with chronic kidney disease

Association of blood pressure variability and neurocognition in children with chronic kidney disease

Depressive Symptoms in Children with Chronic Kidney Disease

Consequences of CKD on Functioning

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