Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis

Kerry Chen; Madeleine Didsbury; Anita van Zwieten; Martin Howell; Siah Kim; Allison Tong; Kirsten Howard; Natasha Nassar; Belinda Barton; Suncica Lah; Jennifer Lorenzo; Giovanni Strippoli; Suetonia Palmer; Armando Teixeira-Pinto; Fiona Mackie; Steven McTaggart; Amanda Walker; Tonya Kara; Jonathan C. Craig; Germaine Wong

doi:10.2215/CJN.09650917

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Figure 1.
Preferred reporting items for systematic reviews and meta-analyses flowchart. Thirty-four studies were included for systematic review (25 cross-sectional, 9 cohort). IQ, intelligence quotient.
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Figure 2.
Significant deficits observed in children with CKD. A shows full-scale intelligence quotient (IQ) between children with and without CKD. B shows verbal and performance IQ between children with and without CKD. 95% CI, 95% confidence interval; df, degree of freedom; IV, inverse variance; SE, SEM.
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Figure 3.
Risk of bias assessment. The overall risk of bias was high.
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Figure 4.
Subgroup analyses of full-scale intelligence quotient in children with and without CKD (mild to moderate stage CKD). 95% CI, 95% confidence interval; df, degree of freedom; IV, inverse variance; SE, SEM.

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Table 1.

Characteristics of included studies

Characteristic	N (%)
Study related
Year of publication
2010 to present	14 (41)
2000–2009	10 (29)
Pre-2000	10 (29)
Country of publication
United States	20 (59)
The Netherlands	3 (9)
Canada	2 (6)
Egypt	2 (6)
Finland	2 (6)
Other	5 (15)
No. of patients per study (n)
0–99	27 (79)
100–199	5 (15)
200+	2 (6)
Study design
Cross-sectional	25 (74)
Cohort	9 (26)
Patient related
Mean age, yr^a
0–6	3 (9)
7–12	16 (47)
13+	13 (38)
Stages of CKD^b
Mild to moderate stage CKD	25 (74)
Dialysis	6 (18)
Transplant	15 (44)
Use of controls^b
Direct non-CKD controls	19 (56)
Normative population data	28 (82)
Test related
Outcome domains
Intelligence	25 (74)
Academic achievement	10 (29)
Attention	11 (32)
Executive function	9 (26)
Memory	12 (35)
Intelligence
Wechsler scales (IQ)	22 (65)
Stanford Binet Intelligence Test	2 (6)
Test of nonverbal intelligence	1 (3)
Other	9 (26)
Attention
Conners Continuous Performance Task	5 (15)
Continuous performance task^c	3 (9)
Gordon Diagnostic System	2 (6)
Other	8 (24)
Executive function
Behavior Rating Inventory of Executive Function	5 (15)
Delis–Kaplan Executive Function System	2 (6)
Halstead–Reitan Category Test	2 (6)
Other	8 (24)
Memory
Wide range assessment of memory and learning	5 (15)
Nonverbal selective reminding test	2 (6)
Other	9 (26)
Academic achievement
Wechsler Individual Achievement Test	6 (18)
Wide Range Achievement Test	3 (9)
Peabody Individual Achievement Test	2 (6)
Other	2 (6)
Subtests^c
Full-scale IQ	21 (62)
Verbal IQ	18 (53)
Performance IQ	16 (47)
Reading	8 (24)
Arithmetic	8 (24)
Spelling	4 (12)

IQ, intelligence quotient.
↵a Two studies did not specify.
↵b There is overlap in the number of studies.
↵c Not all studies reporting outcomes contained data suitable for meta-analysis.