While chronic kidney disease (CKD) clearly affects a child’s physical health, new research suggests that it can also have a negative impact on neurocognitive function, academic performance and mental health. These effects can result in long-term consequences for children with CKD as they transition into adulthood.
The findings, published in the Clinical Journal of the American Society of Nephrology (CJASN), show that childhood CKD may lead to mild deficits across academic skills, executive function, and visual and verbal memory.
For the analysis, researchers examined all of the published evidence on cognitive and academic outcomes in children and adolescents with CKD. Their analysis included 34 studies involving more than 3,000 CKD patients under the age of 21 years.
The findings suggest that children with CKD tend to have low-average neurocognitive and academic outcomes. The global cognition IQ of children with CKD was classified as low-average. Compared with the general population, the average differences in IQ were as follows: -10.5 for all CKD stages, -9.39 for patients with mild-to-moderate stage CKD, -11.2 for patients who underwent kidney transplantation, and -16.2 for patients on dialysis.
Direct comparisons revealed that children with mild-to-moderate stage CKD and those who received kidney transplants scored 11.2 and 10.1 IQ points higher than those on dialysis.
Children with CKD also had lower scores than the general population in executive function and memory domains, and they scored lower in tests of academic skills related to mathematics, reading, and spelling.
“In translating our findings to clinical practice, this research provides relevant information on the areas of need — for example, working memory and mathematics — for which children with CKD may need guidance, practice and assistance, particularly for children on dialysis,” said Kerry Chen, M.B.B.S., at the Centre for Kidney Research, University of Sydney, in Australia.
“It also suggests hypotheses for why the overall intellectual and educational outcomes of children with CKD are reduced compared with the general population, and how best to prevent deficits.”
In an accompanying Patient Voice editorial in CJASN, Lori Hartwell, Founder and President of the Renal Support Network, who has had kidney disease since two years of age wrote, “I recall occasions while on hemodialysis experiencing poor cognition and difficulty retaining information.”
“It is not surprising that children and adolescents on dialysis are at greater risk of such effects. Studies have shown a decline in cognitive function that has been associated with fluid and solute shifts while undergoing hemodialysis.”
Source: American Society of Nephrology