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Original ArticlesClinical Nephrology
Open Access

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 and Germaine Wong
CJASN March 2018, 13 (3) 387-397; DOI: https://doi.org/10.2215/CJN.09650917
Kerry Chen
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Madeleine Didsbury
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Anita van Zwieten
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Martin Howell
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Siah Kim
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Allison Tong
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Kirsten Howard
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Natasha Nassar
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Belinda Barton
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Suncica Lah
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Jennifer Lorenzo
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Giovanni Strippoli
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Suetonia Palmer
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Armando Teixeira-Pinto
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Fiona Mackie
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Steven McTaggart
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Amanda Walker
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Tonya Kara
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Jonathan C. Craig
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Germaine Wong
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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

    CharacteristicN (%)
    Study related
     Year of publication
      2010 to present14 (41)
      2000–200910 (29)
      Pre-200010 (29)
     Country of publication
      United States20 (59)
      The Netherlands3 (9)
      Canada2 (6)
      Egypt2 (6)
      Finland2 (6)
      Other5 (15)
     No. of patients per study (n)
      0–9927 (79)
      100–1995 (15)
      200+2 (6)
     Study design
      Cross-sectional25 (74)
      Cohort9 (26)
    Patient related
     Mean age, yra
      0–63 (9)
      7–1216 (47)
      13+13 (38)
     Stages of CKDb
      Mild to moderate stage CKD25 (74)
      Dialysis6 (18)
      Transplant15 (44)
     Use of controlsb
      Direct non-CKD controls19 (56)
      Normative population data28 (82)
    Test related
     Outcome domains
      Intelligence25 (74)
      Academic achievement10 (29)
      Attention11 (32)
      Executive function9 (26)
      Memory12 (35)
     Intelligence
      Wechsler scales (IQ)22 (65)
      Stanford Binet Intelligence Test2 (6)
      Test of nonverbal intelligence1 (3)
      Other9 (26)
     Attention
      Conners Continuous Performance Task5 (15)
      Continuous performance taskc3 (9)
      Gordon Diagnostic System2 (6)
      Other8 (24)
     Executive function
      Behavior Rating Inventory of Executive Function5 (15)
      Delis–Kaplan Executive Function System2 (6)
      Halstead–Reitan Category Test2 (6)
      Other8 (24)
     Memory
      Wide range assessment of memory and learning5 (15)
      Nonverbal selective reminding test2 (6)
      Other9 (26)
     Academic achievement
      Wechsler Individual Achievement Test6 (18)
      Wide Range Achievement Test3 (9)
      Peabody Individual Achievement Test2 (6)
      Other2 (6)
     Subtestsc
      Full-scale IQ21 (62)
      Verbal IQ18 (53)
      Performance IQ16 (47)
      Reading8 (24)
      Arithmetic8 (24)
      Spelling4 (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.

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Clinical Journal of the American Society of Nephrology: 13 (3)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 3
March 07, 2018
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Neurocognitive and Educational Outcomes in Children and Adolescents with CKD
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
CJASN Mar 2018, 13 (3) 387-397; DOI: 10.2215/CJN.09650917

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Neurocognitive and Educational Outcomes in Children and Adolescents with CKD
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
CJASN Mar 2018, 13 (3) 387-397; DOI: 10.2215/CJN.09650917
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Keywords

  • chronic kidney disease
  • pediatrics
  • epidemiology and outcomes
  • transplant outcomes
  • dialysis
  • Neurocognition
  • education
  • child
  • adolescent
  • Humans
  • Cross-Sectional Studies
  • Executive Function
  • Reading
  • Transplant Recipients
  • kidney transplantation
  • Confidence Intervals
  • Cohort Studies
  • Cognition
  • Renal Insufficiency, Chronic
  • Memory
  • Mathematics
  • bias
  • Intelligence

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