Duration of chronic kidney disease reduces attention and executive function in pediatric patients.
Duration of chronic kidney disease reduces attention and executive function in pediatric patients.
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DOI：
10.1038/ki.2014.323
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发表时间：
2015-04
影响因子：
19.6
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儿童期慢性肾病（CKD）与神经认知缺陷相关。受影响的儿童在智力测试中的表现比他们未受影响的兄弟姐妹更差，并且倾向于正常范围的低端。在这里，我们进一步评估了来自北美48个儿科中心的340名儿童慢性肾脏病队列中的轻中度CKD儿童患者（6至21岁）的这种关联。参与者进行了一系列与年龄相适应的测试，包括Conner的连续性能测试-II（CPT-II），Delis-Kaplan执行功能系统塔任务，以及与年龄相适应的Wechsler智力量表的数字跨度向后任务。在估计的GFR和CKD持续时间范围内比较测试性能，相关协变量包括母亲教育，家庭收入，智商，血压和早产。在340名患者中，35%的患者在至少一项执行功能测试中表现不佳（低于平均值1.5或更多标准差）。通过单变量非参数比较和多元Logistic回归分析，慢性肾脏病病程较长与CPT-II委员会错误（注意力调节和抑制控制测试）表现不佳的比值比增加相关。因此，在轻度至中度CKD人群中，与注意力调节和抑制控制受损相关的是疾病持续时间，而不是估计的GFR。
Chronic kidney disease (CKD) in childhood is associated with neurocognitive deficits. Affected children show worse performance on tests of intelligence than their unaffected siblings and skew toward the lower end of the normal range. Here we further assessed this association in 340 pediatric patients (ages 6 to 21) with mild-moderate CKD in The Chronic Kidney Disease in Childhood cohort from 48 pediatric centers in North America. Participants underwent a battery of age-appropriate tests including Conner’s Continuous Performance Test-II (CPT-II), Delis- Kaplan Executive Function System Tower task, and the Digit Span Backwards task from the age-appropriate Wechsler Intelligence Scale. Test performance was compared across the range of estimated GFR and duration of CKD with relevant covariates including maternal education, household income, IQ, blood pressure and preterm birth. Among the 340 patients, 35% had poor performance (below the mean by1.5 or more standard deviations) on at least one test of executive function. By univariate nonparametric comparison and multiple logistic regression, longer duration of CKD was associated with increased odds ratio for poor performance on the CPT-II Errors of Commission, a test of attention regulation and inhibitory control. Thus, in a population with mild to moderate CKD, the duration of disease rather than estimated GFR was associated with impaired attention regulation and inhibitory control.