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

Affiliations
  • 1Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
  • 2Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
  • 3Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
  • 4Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
  • 5Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Korea
  • 6Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
  • 7Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 8Department of Pediatrics, Asan Medical Center Childrens' Hospital, University of Ulsan College of Medicine, Seoul, Korea
  • 9Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
  • 10Department of Pediatrics, College of Medicine, Jeju National University, Jeju, Korea

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
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