Abstract
Pediatric chronic kidney disease (CKD) appears to be a heterogeneous group of conditions, but this heterogeneity has not been explored with respect to its impact on neurocognitive functioning. This study investigated the neurocognitive functioning of those with glomerular (G) vs. non-glomerular (NG) diagnoses. Data from the North American CKiD Study were employed and the current study included 1,003 children and adolescents with mild to moderate CKD. The G Group included 260 participants (median age = 14.7 years) and the NG Group included 743 individuals (median age = 9.0 years). Neurocognitive measures assessed IQ, inhibitory control, attention regulation, problem solving, working memory, and overall executive functioning. Data from all visits were included in the linear mixed model analyses. After adjusting for sociodemographic and CKD-related covariates, results indicated no differences between the diagnostic groups on measures of IQ, problem solving, working memory, and attention regulation. There was a trend for the G group to receive better parent ratings on their overall executive functions (p < 0.07), with a small effect size being present. Additionally, there was a significant G group X hypertension interaction (p < 0.003) for inhibitory control, indicating that those with both a G diagnosis and hypertension performed more poorly than the NG group with hypertension. These findings suggest that the separation of G vs. NG CKD produced minimal, but specific group differences were observed. Ongoing examination of the heterogeneity of pediatric CKD on neurocognition, perhaps at a different time point in disease progression or using a different model, appears warranted.
Highlights
It is known in both adult and pediatric literature that one potential health-related problem pertaining to chronic kidney disease (CKD) is the disruption of neurocognitive functioning
There have been no studies in pediatric CKD that have examined the interaction between hypertension and type of CKD
The primary question for this study pertained to the neurocognitive similarities and differences between children adolescents with G vs. NG diagnoses in order to address potential heterogeneity of pediatric CKD
Summary
It is known in both adult and pediatric literature that one potential health-related problem pertaining to chronic kidney disease (CKD) is the disruption of neurocognitive functioning. Hooper et al [1,2,3] found that these neurocognitive difficulties are present even in children and adolescents with mild to moderate CKD, with lower performance being noted in IQ, attention regulation, and parent ratings of executive functions. In a comprehensive review of available pediatric findings, Chen et al [5] documented an array of neurocognitive difficulties, including executive dysfunction, in children and adolescents with CKD. Nephrotic proteinuria has been associated with lower neurocognitive functioning in crosssectional studies in this population [1] and an independent correlate of CKD progression in children and adolescents with NG CKD [14]; few studies, if any, have addressed the interaction of type of kidney disease and nephrotic proteinuria.
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