Casual Blood Pressure and Neurocognitive Function in Children with Chronic Kidney Disease: A Report of the Children with Chronic Kidney Disease Cohort Study
Casual Blood Pressure and Neurocognitive Function in Children with Chronic Kidney Disease: A Report of the Children with Chronic Kidney Disease Cohort Study
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DOI：
10.2215/cjn.00810111
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发表时间：
2011-08-01
影响因子：
9.8
通讯作者：
Flynn, Joseph T.
中科院分区：
文献类型：
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作者：
Lande, Marc B.;Gerson, Arlene C.;Flynn, Joseph T.
背景和目标 患有慢性肾脏病 (CKD) 的儿童面临认知功能障碍的风险，其中一半以上患有高血压。关于高血压对儿童 CKD 相关神经认知缺陷的潜在影响的数据有限。我们的目的是确定与患有 CKD 和正常血压的儿童相比，患有 CKD 和血压升高 (EBP) 的儿童在神经认知测试中的表现是否下降。设计、设置、参与者和测量这是对参加儿童慢性肾病 (CKiD) 项目的 6 至 17 岁儿童的听诊血压和神经认知测试表现之间关系的横断面分析。结果 在 383 名受试者中，132 名 (34%) EBP（收缩压和/或舒张压 >= 90（th）百分位）。患有 EBP 的受试者在韦氏简略智力量表 (WASI) 表现智商上的平均 (SD) 分数低于血压正常的受试者（正常血压与 EBP，96.1 (16.7) 与 92.4 (14.9)，P = 0.03）和 WASI 全量表智商（97.0 (16.2) 与 93.4 (16.5)，P = 0.04）。血压指数（受试者的血压/95（th）百分位血压）与表现智商得分呈负相关（收缩压，r = -0.13，P = 0.01；舒张压，r = -0.19，P < 0.001）。在多变量分析中，控制人口和疾病相关变量后，较低的表现智商得分与血压升高之间的关联仍然显着（EBP，β = -3.7，95% 置信区间 [CI]：-7.3 至 -0.06；收缩压指数，β = -1.16 至 95% CI：-2.1，-0.21；舒张压指数，β = -1.17，95% CI：-1.8 至 -0.55)。结论 对于轻度至中度 CKD 儿童，较高的血压与 WASI 表现智商得分下降独立相关。 Clin J Am Soc Nephrol 6：1831-1837，2011。doi：10.2215/CJN.00810111
Background and objectives Children with chronic kidney disease (CKD) are at risk for cognitive dysfunction, and over half have hypertension. Data on the potential contribution of hypertension to CKD-associated neurocognitive deficits in children are limited. Our objective was to determine whether children with CKD and elevated BP (EBP) had decreased performance on neurocognitive testing compared with children with CKD and normal BP.Design, setting, participants, & measurements This was a cross-sectional analysis of the relation between auscultatory BP and neurocognitive test performance in children 6 to 17 years enrolled in the Chronic Kidney Disease in Children (CKiD) project.Results Of 383 subjects, 132 (34%) had EBP (systolic BP and/or diastolic BP >= 90(th) percentile). Subjects with EBP had lower mean (SD) scores on Wechsler Abbreviated Scales of Intelligence (WASI) Performance IQ than those with normal BP (normal BP versus EBP, 96.1 (16.7) versus 92.4 (14.9), P = 0.03) and WASI Full Scale IQ (97.0 (16.2) versus 93.4 (16.5), P = 0.04). BP index (subject's BP/95(th) percentile BP) correlated inversely with Performance IQ score (systolic, r = -0.13, P = 0.01; diastolic, r = -0.19, P < 0.001). On multi-variate analysis, the association between lower Performance IQ score and increased BP remained significant after controlling for demographic and disease-related variables (EBP, beta = -3.7, 95% confidence interval [CI]: -7.3 to -0.06; systolic BP index, beta = -1.16 to 95% CI: -2.1, -0.21; diastolic BP index, beta = -1.17, 95% CI: -1.8 to -0.55).Conclusions Higher BP was independently associated with decreased WASI Performance IQ scores in children with mild-to-moderate CKD. Clin J Am Soc Nephrol 6: 1831-1837, 2011. doi: 10.2215/CJN.00810111