The Impact of Pediatric CKD on Educational and Employment Outcomes.

Abstract

Pediatric patients with chronic kidney disease (CKD) are at risk for neurocognitive deficits and academic underachievement. This population may be at risk for lower educational attainment and higher rates of unemployment; however, published data has focused on patients with advanced CKD and exist in isolation from assessment of neurocognition and kidney function. Data from the Chronic Kidney Disease in Children (CKiD) cohort study were used to characterize educational attainment and employment status in young adults with CKD. We utilized ratings of executive function as a predictor of future educational attainment and employment status. Linear regression models predicted the highest grade level completed. Logistic regression models predicted unemployment. 296 CKiD participants aged 18 years or older had available educational data. 220/296 had employment data. By age 22, 97% had completed high school and 48% completed 2+ years of college. Among those reporting employment status, 58% were part- or full-time employed, 22% were non-working students, and 20% were unemployed and/or receiving disability. In adjusted models, lower kidney function (p=0.02), worse executive function (p=0.02), and poor performance on achievement testing (p=0.004) predicted lower grade level completed relative to expectation for age. CKiD study patients appear to have a better high school graduation rates (97%) than the adjusted national high school graduation rate (86%). Conversely, roughly 20% of participants were unemployed or receiving disability at study follow-up. Tailored interventions may benefit CKD patients with lower kidneyfunction and/or executive function deficits to optimize educational/employment outcomes in adulthood.