The Similarities and Differences Between Glomerular vs. Non-glomerular Diagnoses on Intelligence and Executive
Stephen R Hooper1, Rebecca J Johnson2, Marc Lande3
1Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States.
Insights
Pediatric chronic kidney disease (CKD) heterogeneity impacts neurocognition minimally. Glomerular vs. non-glomerular diagnoses showed few differences, except for inhibitory control in hypertensive patients.
Area of Science:
- Pediatric Nephrology
- Neuropsychology
- Chronic Kidney Disease Research
Background:
- Pediatric chronic kidney disease (CKD) is heterogeneous, but its impact on neurocognitive functioning is not well understood.
- Previous research has not explored neurocognitive differences based on glomerular (G) versus non-glomerular (NG) CKD diagnoses.
Purpose of the Study:
- To investigate neurocognitive functioning in children and adolescents with CKD, comparing those with glomerular (G) versus non-glomerular (NG) diagnoses.
- To determine if CKD diagnostic category influences specific neurocognitive domains.
Main Methods:
- Utilized data from the North American CKiD Study, including 1,003 children and adolescents with mild to moderate CKD.
- Compared neurocognitive measures (IQ, inhibitory control, attention, problem solving, working memory, executive functioning) between the G Group (n=260) and NG Group (n=743).
- Employed linear mixed model analyses, adjusting for relevant covariates.
Main Results:
- No significant differences were found between G and NG groups in IQ, problem solving, working memory, or attention regulation.
- A trend suggested better overall executive function ratings for the G group (p < 0.07).
- A significant interaction between G diagnosis and hypertension was observed for inhibitory control (p < 0.003), with hypertensive G-CKD patients performing worse.
Conclusions:
- The distinction between glomerular and non-glomerular pediatric CKD has minimal impact on most neurocognitive functions.
- Specific differences in inhibitory control were noted in patients with glomerular CKD and hypertension.
- Further research is warranted to explore pediatric CKD heterogeneity's effects on neurocognition across different disease stages or models.
Abstract:
Pediatric chronic kidney disease (CKD) appears to be a heterogeneous group of conditions, but this heterogeneity has not been explored with respect to its impact on neurocognitive functioning. This study investigated the neurocognitive functioning of those with glomerular (G) vs. non-glomerular (NG) diagnoses. Data from the North American CKiD Study were employed and the current study included 1,003 children and adolescents with mild to moderate CKD. The G Group included 260 participants (median age = 14.7 years) and the NG Group included 743 individuals (median age = 9.0 years). Neurocognitive measures assessed IQ, inhibitory control, attention regulation, problem solving, working memory, and overall executive functioning. Data from all visits were included in the linear mixed model analyses. After adjusting for sociodemographic and CKD-related covariates, results indicated no differences between the diagnostic groups on measures of IQ, problem solving, working memory, and attention regulation. There was a trend for the G group to receive better parent ratings on their overall executive functions (p < 0.07), with a small effect size being present. Additionally, there was a significant G group X hypertension interaction (p < 0.003) for inhibitory control, indicating that those with both a G diagnosis and hypertension performed more poorly than the NG group with hypertension. These findings suggest that the separation of G vs. NG CKD produced minimal, but specific group differences were observed. Ongoing examination of the heterogeneity of pediatric CKD on neurocognition, perhaps at a different time point in disease progression or using a different model, appears warranted.
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