S KIM 1,2, A VAN ZWIETEN 1,2, R KHALID 1,2, S LAH 3, J LORENZO 4, A FRANCIS 1,2,5, S MCTAGGART 5, A WALKER 9, F MACKIE 6,11, C PRESTIDGE 7, A TEIXEIRA-PINTO 1,2, A TONG 1,2, K BLAZEK 1,2, B BARTON 8, J CRAIG 1,12, G WONG 1,2,10
1Centre For Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 2Sydney School of Public Health, University of Sydney, Camperdown, Australia, 3School of Psychology, The University of Sydney, Camperdown, Australia, 4Kid’s Neuroscience Centre, The Children’s Hospital at Westmead, Westmead, Australia, 5Child and Aldolescent Renal Service, Queensland Children’s Hospital, Brisbane, Australia, 6Department of Nephrology, Sydney Children’s Hospital Randwick, Randwick, Australia, 7Department of Nephrology, Starship Children’s Hospital, Auckland, New Zealand, 8Children’s Hospital Education Research Institute, The Children’s Hospital at Westmead, Westmead, Australia, 9Department of Nephrology, Royal Children’s Hospital, Parkville, Australia, 10Centre for Transplant and Renal Research, Westmead Hospital , Westmead, Australia, 11School of Women’s and Children’s Health, University of NSW, Randwick, Australia, 12College of Medicine and Public Health, Flinders University, Bedford Park, Australia
Aim: To determine the longitudinal impact of reduced kidney function on the cognitive and academic performance of children with chronic kidney disease (CKD).
Background: Little is known about the cognitive and academic functioning of children with CKD over the trajectory of disease.
Methods:We included 53 participants (aged 6-18 years) with CKD stages 1-5 (n=27), or on kidney replacement therapy (KRT, dialysis or transplant; n=25) from 3 paediatric nephrology units in Australia between 2015 and 2020. We used linear regression and linear mixed effects models to investigate the effect of CKD stage on cognitive and academic outcomes, adjusted for socioeconomic status.
Results: Participants’ mean age was 12 years (SD 2.5) and 37 were male (70%). The average full-scale IQ (FSIQ) (95%CI) of children on KRT was 87 (78 to 96). For children on KRT, average scores for academic achievement on numerical operations, word reading and spelling were 89 (82 to 95), 99 (92 to 106) and 91 (86 to 98), respectively. The mean (95%CI) FSIQ, word reading, numerical operations and spelling scores for children on KRT were 14.3 (-25.3 to – 3.3), 11 (-18.5 to – 3.6), 8.5 (-17.6 to 0.76) and 10 (-18.6 to -1.3) points lower than children not on KRT. Over time, spelling and numerical operation scores declined by 0.7 (-1.4 to -0.1) and 1.0 (-2.0 to 0.2) units per year increase in age, in all children regardless of CKD stage.
Conclusions:Children treated with KRT have lower than average cognitive abilities with deficits in academic performance for numeracy and literacy. However, the rate of decline in the academic performance are similar for children across the full spectrum of CKD.
Dr Siah Kim is a paediatric nephrologist working at The Children’ Hospital at Westmead and Sydney School of Public Health. She completed her PhD in 2015 at the Centre for Kidney Research looking at early markers of kidney disease among Aboriginal children and adolescents. Her research interests include improving safety and outcomes for paediatric kidney transplant recipients.