Journal article
Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis
Clinical journal of the American Society of Nephrology, Vol.13, pp.387-397
07/03/2018
PMCID: PMC5967677
PMID: 29472306
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Source: InCites
Abstract
Background and objectives
Poor cognition can affect educational attainment, but the extent of neurocognitive impairment in children with CKD is not well understood. This systematic review assessed global and domain-specific cognition and academic skills in children with CKD and whether these outcomes varied with CKD stage.
Design, setting, participants, & measurements
Electronic databases were searched for observational studies of children with CKD ages 21 years old or younger that assessed neurocognitive or educational outcomes. Risk of bias was assessed using a modified Newcastle–Ottawa scale. We used random effects models and expressed the estimates as mean differences with 95% confidence intervals stratified by CKD stage.
Results
Thirty-four studies (25 cross-sectional, n=2095; nine cohort, n=991) were included. The overall risk of bias was high because of selection and measurement biases. The global cognition (full-scale intelligence quotient) of children with CKD was classified as low average. Compared with the general population, the mean differences (95% confidence intervals) in full-scale intelligence quotient were −10.5 (95% confidence interval, −13.2 to −7.72; all CKD stages, n=758), −9.39 (95% confidence interval, −12.6 to −6.18; mild to moderate stage CKD, n=582), −16.2 (95% confidence interval, −33.2 to 0.86; dialysis, n=23), and −11.2 (95% confidence interval, −17.8 to −4.50; transplant, n=153). Direct comparisons showed that children with mild to moderate stage CKD and kidney transplants scored 11.2 (95% confidence interval, 2.98 to 19.4) and 10.1 (95% confidence interval, −1.81 to 22.0) full-scale intelligence quotient points higher than children on dialysis. Children with CKD also had lower scores than the general population in executive function and memory (verbal and visual) domains. Compared with children without CKD, the mean differences in academic skills (n=518) ranged from −15.7 to −1.22 for mathematics, from −9.04 to −0.17 for reading, and from −14.2 to 2.53 for spelling.
Conclusions
Children with CKD may have low-average cognition compared with the general population, with mild deficits observed across academic skills, executive function, and visual and verbal memory. Limited evidence suggests that children on dialysis may be at greatest risk compared with children with mild to moderate stage CKD and transplant recipients.
Details
- Title
- Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis
- Creators
- Kerry ChenMadeleine DidsburyAnita van ZwietenMartin HowellSiah KimAllison TongKirsten HowardNatasha NassarBelinda BartonSuncica LahJennifer LorenzoGiovanni StrippoliSuetonia PalmerArmando Teixeira-PintoFiona MackieSteven McTaggartAmanda WalkerTonya KaraJonathan C CraigGermaine Wong
- Publication Details
- Clinical journal of the American Society of Nephrology, Vol.13, pp.387-397
- Publisher
- American Society of Nephrology
- Identifiers
- 991013093611302368
- Copyright
- Copyright © 2018 by the American Society of Nephrology
- Academic Unit
- Faculty of Health
- Language
- English
- Resource Type
- Journal article