Assessment of cognitive functions and adaptive behavior in children with end-stage renal disease on regular hemodialysis

Shahawy, Azza Kamal Al; El-Gamasy, Mohamed Abdelaziz; Seleem, Mohammed; Mawlana, Wegdan; Sharkaway, Amira Hassan El

doi:10.4103/1319-2442.284014

Cited by 4 publications

(2 citation statements)

References 37 publications

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“…In fact, MacEwen et al 37 have shown a significant linear relationship between low MAP thresholds and a decrease in cerebral oxygenation during HD in adults. Pediatric patients on HD are known to have cognitive challenges and poor adaptive behavior and executive functioning, which improve after transplantation 50 51 Because the NIRS probe only identifies perfusion abnormalities in the region of the sensor, subtle changes in other regions of the brain, including in white matter, may have been missed by our study.…”

Section: Discussionmentioning

confidence: 98%

“…Pediatric patients on HD are known to have cognitive challenges and poor adaptive behavior and executive functioning, which improve after transplantation. 50,51 Because the NIRS probe only identifies perfusion abnormalities in the region of the sensor, subtle changes in other regions of the brain, including in white matter, may have been missed by our study. The role of HD-induced cerebral stress in the cognitive and executive function of patients on HD deserves further study in pediatric patients.…”

Section: Wwwjasnorg Clinical Researchmentioning

confidence: 92%

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Preserved Cerebral Oxygenation with Worsening Global Myocardial Strain during Pediatric Chronic Hemodialysis

Idrovo

Pignatelli

Loar

et al. 2021

JASN

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Background Cerebral and myocardial hypoperfusion occur during hemodialysis in adults. Pediatric patients receiving chronic hemodialysis have fewer cardiovascular risk factors, yet cardiovascular morbidity remains prominent. Methods We conducted a prospective observational study of pediatric patients receiving chronic hemodialysis to investigate whether intermittent hemodialysis is associated with adverse end organ effects in the heart or with cerebral oxygenation (regional O2 saturation [rSO2]). We assessed intradialytic cardiovascular function and rSO2, using noninvasive echocardiography to determine myocardial strain and continuous noninvasive nearinfrared spectroscopy for rSO2. We measured changes in blood volume and central venous oxygen saturation (mCVO2) were pre-, mid-, and post-hemodialysis. Results The study included 15 patients (median age, 12 years; median hemodialysis vintage 13.2 [9, 24] months were included. Patients were asymptomatic. The rSO2 did not change during hemodialysis, whereas mCVO2 decreased significantly, from 73% to 64.8 %. Global longitudinal strain of the myocardium worsened significantly by mid-hemodialysis and persisted post-hemodialysis. The ejection fraction remained normal. Lower systolic blood pressure and faster blood volume change were associated with worsening myocardial strain; only blood volume change was significant in multivariate analysis (β coefficient, -0.3; 95% confidence interval [95% CI], −0.38 to −0.21; P=0.0001). Blood volume change was also associated with a significant decrease in mCVO2 (β coefficient 0.42; 95% CI, 0.07 to 0.76; P=0.001). Access, age, hemodialysis vintage, and ultrafiltration volume were not associated with worsening strain. Conclusion s Unchanged rSO2 suggested that cerebral oxygenation was maintained during hemodialysis. However, despite maintained ejection fraction, intradialytic myocardial strain worsened in pediatric hemodialysis and was associated with blood volume change. The effect of hemodialysis on individual organ perfusion in pediatric versus adult patients receiving hemodialysis might differ.

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Section: Discussionmentioning

confidence: 98%

Section: Wwwjasnorg Clinical Researchmentioning

confidence: 92%

Preserved Cerebral Oxygenation with Worsening Global Myocardial Strain during Pediatric Chronic Hemodialysis

Idrovo

Pignatelli

Loar

et al. 2021

JASN

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Assessing and Intervening with Children who are Chronically Ill

Colaluca¹

2022

Best Practices in School Neuropsychology

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Neurocognitive and Adaptive Functioning in Young Patients with Severe Chronic Kidney Disease

Sophie,

Jasmijn,

Lotte

et al. 2024

J Clini Nephrol

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Background: To assess the association between neurocognitive functioning, adaptive functioning, and health-related quality of life (HRQoL), in Children and Young Adults with Severe Chronic Kidney Disease (CKD). Methods: We included patients with severe CKD (stages 4 and 5), aged 8-30 years, on different therapy modalities (pre-dialysis, dialysis, and transplanted) and healthy controls matched on age, sex, and parental education. All patients and healthy controls performed tasks to assess neurocognitive functioning (WISC/WAIS and a comprehensive neuropsychological test battery), and completed questionnaires to assess adaptive functioning (WFIRS or WHODAS) and HRQoL (PedsQL). Group differences were explored using MANCOVA. Mediation analyses were done to explore whether the relation between neurocognitive functioning and HRQoL was mediated by adaptive functioning. Results: 28 patients with severe CKD and 21 healthy matched controls were included. CKD patients had worse HRQoL (p < .001) than healthy controls. Adaptive functioning problems increased with age in the CKD patient group but not in the healthy control group (significant interaction effect: p = .024). Significant mediation effects were found, where impaired adaptive functioning mediated the relation between both low estimated Full Scale Intelligence Quotient (eFSIQ) and worse Processing Speed & Working Memory, and impaired HRQoL (eFSIQ: 95% confidence interval = .01-.58; Processing Speed & Working Memory: 95% confidence interval = 2.31-16.36). Conclusion: We found that impaired neurocognitive functioning is associated with worse HRQoL, which is conditional to impaired adaptive functioning. Especially towards young adulthood problems in adaptive functioning are more likely to be reported than when patients are younger.

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Assessment of cognitive functions and adaptive behavior in children with end-stage renal disease on regular hemodialysis

Cited by 4 publications

References 37 publications

Preserved Cerebral Oxygenation with Worsening Global Myocardial Strain during Pediatric Chronic Hemodialysis

Preserved Cerebral Oxygenation with Worsening Global Myocardial Strain during Pediatric Chronic Hemodialysis

Assessing and Intervening with Children who are Chronically Ill

Neurocognitive and Adaptive Functioning in Young Patients with Severe Chronic Kidney Disease

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