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Neurocognitive, Social-Behavioral, and Adaptive Functioning in Preschool Children with Mild to Moderate Kidney Disease

Hooper, Stephen R. PhD; Gerson, Arlene C. PhD; Johnson, Rebecca J. PhD; Mendley, Susan R. MD; Shinnar, Shlomo MD; Lande, Marc B. MD; Matheson, Matthew B. MA; Gipson, Debbie S. MD; Morgenstern, Bruce MD; Warady, Bradley A. MD; Furth, Susan L. MD

Journal of Developmental & Behavioral Pediatrics: April 2016 - Volume 37 - Issue 3 - p 231–238
doi: 10.1097/DBP.0000000000000267
Original Articles

Objective: The negative impact of end-stage kidney disease on cognitive function in children is well established, but no studies have examined the neurocognitive, social-behavioral, and adaptive behavior skills of preschool children with mild to moderate chronic kidney disease (CKD).

Method: Participants included 124 preschool children with mild to moderate CKD, aged 12 to 68 months (median = 3.7 years), and an associated mean glomerular filtration rate (GFR) of 50.0 mL·min−1·1.73 m−2. In addition to level of function and percent of participants scoring ≥1 SD below the test mean, regression models examined the associations between biomarkers of CKD (GFR, anemia, hypertension, seizures, and abnormal birth history), and developmental level/IQ, attention regulation, and parent ratings of executive functions, social-behavior, and adaptive behaviors.

Results: Median scores for all measures were in the average range; however, 27% were deemed at risk for a developmental level/IQ <85, 20% were at-risk for attention variability, and parent ratings indicated 30% and 37% to be at risk for executive dysfunction and adaptive behavior problems, respectively. Approximately 43% were deemed at risk on 2 or more measures. None of the disease-related variables were significantly associated with these outcomes, although the presence of hypertension approached significance for attention variability (p < .09). Abnormal birth history and lower maternal education were significantly related to lower developmental level/IQ; seizures were related to lower parental ratings of executive function and adaptive behavior; and abnormal birth history was significantly related to lower ratings of adaptive behavior. When predicting risk status, the logistic regression did evidence both higher GFR and the lack of anemia to be associated with more intact developmental level/IQ.

Conclusion: These findings suggest relatively intact functioning for preschool children with mild to moderate CKD, but the need for ongoing developmental surveillance in this population remains warranted, particularly for those with abnormal birth histories, seizures, and heightened disease severity.

*University of North Carolina School of Medicine, Chapel Hill, NC;

Johns Hopkins Medical Institute, Baltimore, MD;

Children's Mercy, Kansas City, MO;

§University of Maryland School of Medicine, Baltimore, MD;

Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY;

University of Rochester, Rochester, NY;

**Johns Hopkins School of Public Health, Baltimore, MD;

††University of Michigan School of Medicine, Ann Arbor, MI;

‡‡Roseman University College of Medicine, Las Vegas, NV;

§§Children's Hospital of Philadelphia, Philadelphia, PA.

Address for reprints: Stephen R. Hooper, PhD, Departments of Allied Health Sciences and Psychiatry, CB#4120, University of North Carolina School of Medicine, Chapel Hill, NC 27599-4120; e-mail:

S. R. Hooper, has received funding from Children's Hospital of Philadelphia as a Consultant to the NiCKS Project funded by The Commonwealth Universal Research Enhancement Grant with the Pennsylvania Department of Health (#SAP 4100054843).

Disclosure: The authors declare no conflict of interest.

Received June 15, 2015

Accepted December 15, 2015

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