J Korean Med Sci.  2021 May;36(20):e138. 10.3346/jkms.2021.36.e138.

Intellectual Functioning of Pediatric Patients with Chronic Kidney Disease: Results from the KNOW-Ped CKD

• Kang NR
• Ahn YH
• Park E
• Lee KH
• Baek HS
• Kim SH
• Cho H
• Cho MH
• Shin JI
• Lee JH
• Cheong HI
• Kang HG
• Park YS
• Ha IS
• Moon DS
• Han KH

• KMID: 2516050
• DOI: http://doi.org/10.3346/jkms.2021.36.e138

Abstract

Background
Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD.
Methods
Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6–16 years), or Wechsler Adult Intelligence Scale (> 16 years).
Results
The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < −1.88), failure to thrive (weight Z scores < −1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs.
Conclusion
On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time.

Keyword

Intelligence; Chronic Kidney Disease; Children

Figure

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  Fig. 1 Correlation between laboratory findings and full-scale IQ.IQ = intelligence quotient, PTH = parathyroid hormone, 1,25(OH)2D = 1,25-dihydroxyvitamin D, 25(OH)D = 25-hydroxyvitamin D.

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  Fig. 2 Correlation between vitamin D supplements and biochemistry of bone mineral metabolism.CI = confidence interval, PTH = parathyroid hormone, 1,25(OH)2D = 1,25-dihydroxyvitamin D, 25(OH)D = 25-hydroxyvitamin D.*P < 0.05, **P < 0.01, ***P < 0.001.

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