Neurocognitive Functioning of Children and Adolescents with Mild-to-Moderate Chronic Kidney Disease
Neurocognitive Functioning of Children and Adolescents with Mild-to-Moderate Chronic Kidney Disease
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DOI：
10.2215/cjn.09751110
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发表时间：
2011-08-01
影响因子：
9.8
通讯作者：
Warady, Bradley A.
中科院分区：
文献类型：
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作者：
Hooper, Stephen R.;Gerson, Arlene C.;Warady, Bradley A.
背景和目标 关于患有轻至中度慢性肾病 (CKD) 的儿童的神经认知功能的数据很少。本文的主要目标是 (1) 确定该人群的神经认知状态，以及 (2) 确定与神经认知功能相关的社会人口统计学和健康状况变量。设计、设置、参与者和测量这是一项针对儿童慢性肾病 (CKiD) 队列中 368 名 6 至 16 岁儿童的横断面研究。中位 iGFR 为 43 ml/min 每 1.73 m(2)，中位 CKD 持续时间为 8.0 年。大约 26% 患有潜在的肾小球疾病。在研究开始时获得了智力、学业成绩、注意力调节和执行功能的测量结果。神经认知缺陷的患病率是通过将参与者在神经认知功能的每项测量上的得分与规范数据进行比较来确定的。使用多元回归分析评估神经认知功能障碍的假设预测因素之间的关联。结果神经认知功能在整个组的平均范围内；然而，21% 至 40% 的参与者在智商 (IQ)、学业成绩、注意力调节或执行功能方面的得分至少比平均值低 1 个标准差。较高的基于碘海醇的 GFR (iGFR) 预示执行功能测量表现不佳的风险较小。蛋白尿升高（即尿蛋白/肌酐>2）的参与者在语言智商、全面智商和注意力变异性方面的得分低于蛋白尿不升高的参与者。结论虽然大多数患有轻度至中度 CKD 的儿童没有严重的神经认知缺陷，但相当大比例的儿童确实表现出神经认知功能障碍，这使他们面临长期教育和职业结果不佳的风险。 Clin J Am Soc Nephrol 6：1824-1830，2011。doi：10.2215/CJN.09751110
Background and objectives Few data exist on the neurocognitive functioning of children with mild-to-moderate chronic kidney disease (CKD). The primary objectives of this paper are (1) to determine the neurocognitive status in this population and (2) to identify sociodemographic and health-status variables associated with neurocognitive functioning.Design, setting, participants, & measurements This was a cross-sectional study of 368 children, aged 6 to 16 years, from the Chronic Kidney Disease in Children (CKiD) cohort. Median iGFR was 43 ml/min per 1.73 m(2), and the median duration of CKD was 8.0 years. Approximately 26% had underlying glomerular disease. Measures of intelligence, academic achievement, attention regulation, and executive functioning were obtained at study entry. The prevalence of neurocognitive deficits was determined by comparing participant scores on each measure of neurocognitive functioning with normative data. The association between hypothesized predictors of neurocognitive dysfunction was evaluated using multivariate regression analyses.Results Neurocognitive functioning was within the average range for the entire group; however, 21% to 40% of participants scored at least one SD below the mean on measures of intelligence quotient (IQ), academic achievement, attention regulation, or executive functioning. Higher iohexol-based GFR (iGFR) predicted a lesser risk for poor performance on measures of executive function. Participants having elevated proteinuria (i.e., urine protein/creatinine >2) scored lower on verbal IQ, full-scale IQ, and attention variability than those without elevated proteinuria.Conclusions Whereas most children with mild-to-moderate CKD have no major neurocognitive deficits, a substantial percentage did show neurocognitive dysfunction that places them at risk for poor long-term educational and occupational outcomes. Clin J Am Soc Nephrol 6: 1824-1830, 2011. doi: 10.2215/CJN.09751110