Cognitive and academic outcomes in children with chronic kidney disease

Abstract

Background Few data exist on the cognitive and academic functioning of children with chronic kidney disease (CKD) over the trajectory of their illness. We aimed to determine the association between CKD stages and cognitive and academic performance in children over time. Methods We included 53 participants (aged 6–18 years) with CKD stages 1–5 (n = 37), on dialysis (n = 3), or with functioning kidney transplant (n = 22) from three units in Australia from 2015 to 2019. Participants undertook a series of psychometric tests and were invited for repeated assessments annually. We used linear regression and linear mixed models to investigate the effect of CKD stage, adjusted for socioeconomic status. Results At baseline, full-scale intelligence quotient (FSIQ) (95%CI) of children on kidney replacement therapy (KRT) was in the low average range (87: 78, 96) and average (101: 95, 108) for children with CKD 1–5. Mean (95%CI) FSIQ, word reading, numerical operations, and spelling scores for children on KRT were 14.3 (− 25.3, − 3.3), 11 (− 18.5, − 3.6), 8.5 (− 17.6, 0.76), and 10 (− 18.6, − 1.3) points lower than children with CKD Stages 1–5. Spelling and numerical operations scores declined by 0.7 (− 1.4, − 0.1) and 1.0 (− 2.0, 0.2) units per year increase in age, regardless of CKD stage. Conclusions Children treated with KRT have low average cognitive abilities and lower academic performance for numeracy and literacy compared to both children with CKD 1–5 and to the general population. However, the rate of decline in academic performance over time is similar for children across the full spectrum of CKD. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Socioeconomic Position and Health Among Children and Adolescents With CKD Across the Life-Course

“… 13 , 89 , 90 , 91 , 92 , 93 , 94 For children with CKD stage 1 to 5, achievement seems to be in the average to low average range, whereas children on dialysis experience larger academic deficits. 11 , 89 , 92 , 95 Children with kidney transplants seem to be at risk of reduced achievement compared to the general population, but the extent relative to other CKD stages is unclear. 11 , 95 Across all stages, children may be at risk of declining achievement over time.…”

“… 11 , 89 , 92 , 95 Children with kidney transplants seem to be at risk of reduced achievement compared to the general population, but the extent relative to other CKD stages is unclear. 11 , 95 Across all stages, children may be at risk of declining achievement over time. 95 …”

Management of the sensitized pediatric renal transplant candidate

“…(https://optn.transplant.hrsa.gov/data). Long‐term dialysis also has significant implications for the well‐being of patients including increase in mortality, multiple comorbidities including but not limited to short stature, decreased school performance, and cognitive disabilities 3 . Therefore, attempts to perform desensitization to remove or suppress pathogenic HLA antibodies resulting in acceptable crossmatches, and ultimately a successful transplant, while reducing the risk of acute rejection, is much needed in these children 4 .…”

“…multiple comorbidities including but not limited to short stature, decreased school performance, and cognitive disabilities. 3 Therefore, attempts to perform desensitization to remove or suppress pathogenic HLA antibodies resulting in acceptable crossmatches, and ultimately a successful transplant, while reducing the risk of acute rejection, is much needed in these children. 4 In this review, we will discuss strategies to overcome sensitization and share the pediatric protocols that are currently in use at our center.…”

School attendance and sport participation amongst children with chronic kidney disease: a cross-sectional analysis from the Kids with CKD (KCAD) study

“…However, children with chronic kidney disease (CKD) suffer significant survival, quality of life, and developmental disadvantage because of their ill health. Children receiving kidney replacement therapy (KRT), the most advanced stage of CKD, have poorer cognition and academic achievement with mean full-scale intelligence quotient 10.5 lower than the general population [ 1 ] and such gaps worsen over time [ 2 ]. This in turn contributes to lower educational attainment and employment as adults [ 3 , 4 ].…”