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Neurocognition in Pediatric Chronic Kidney Disease: A Review of Data From the Chronic Kidney Disease in Children (CKiD) Study

  • Rebecca J. Johnson
    Affiliations
    Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO
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  • Lyndsay A. Harshman
    Correspondence
    Address reprint requests to Lyndsay A. Harshman, MD, Division of Pediatric Nephrology, Stead Family Department of Pediatrics, University of Iowa Organ Transplant Center, University of Iowa Hospitals and Clinics, SE 425 General Hospital, Iowa City, Iowa 52242
    Affiliations
    Division of Pediatric Nephrology, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA
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      Summary: Pediatric chronic kidney disease (CKD) is associated with deficits in neurocognitive functioning, ranging from mild to severe, and correlated with the severity of kidney disease. Clinical variables that are associated with neurocognitive deficits include lower kidney function, hypertension, proteinuria, and metabolic acidosis. Commonly reported neurocognitive difficulties include academic underachievement and deficits in attention regulation and executive function as well as somewhat lower intellectual abilities compared with peer and normative data. Although often mild, these neurocognitive deficits may have broad implications for quality of life and likely contribute to both poorer high school graduation rates and long-term underemployment in the adult CKD population. The presence of neurocognitive deficits in predialytic CKD has been well characterized, but further longitudinal research is warranted to describe cognitive changes as children progress from early stage CKD to kidney replacement therapy. Such studies should include both cognitive and neuroimaging evaluations to better inform the impact of CKD progression on neurocognitive outcomes.

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