Nephrology 5: CKD/ Diversity and Equity in Kidney Health
56 - Examination of neurocognitive functioning in pediatric congenital anomalies of the kidney and urinary tract (CAKUT)
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 56 Publication Number: 56.35
Camille S. Wilson, Nationwide Children's Hospital, Columbus, OH, United States; Anne E. Dawson, Nationwide Children's Hospital, Columbus, OH, United States; Matthew Matheson, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Lyndsay Harshman, University of Iowa, Iowa City, IA, United States; Marc Lande, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Sharon M. Bartosh, University of Wisconsin, Madison, WI, United States; Amy Kogon, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rebecca J.. Johnson, Children's Mercy Kansas City, Kansas City, MO, United States; Brad A. Warady, Children's Mercy, Kansas City, MO, United States; Susan L. Furth, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Stephen J. Molitor, Medical College of Wisconsin, Milwaukee, WI, United States; Stephen R. Hooper, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
Pediatric Neuropsychologist Nationwide Children's Hospital Columbus, Ohio, United States
Background: Congenital anomalies of the kidney and urinary tract (CAKUT) is a leading cause of chronic kidney disease (CKD) in childhood. Research suggests that children with CKD are at a higher risk for depression and neurocognitive concerns. However, little research has explored how children with CAKUT may differ, or be at specific risk for poorer social-emotional or neurocognitive outcomes relative to youth with CKD who do not have CAKUT. Objective: Study aims explored how specific neuro/psychological outcomes differ between CAKUT and non-CAKUT groups within the Chronic Kidney Disease in Children (CKiD) study. Design/Methods: The CKiD study is a multi-site prospective study of children with mild to moderate CKD. Mixed linear models were employed and outcome variables of interest included parent reported executive functioning (BRIEF Global Executive Composite) and behavioral symptoms on the BASC-2, adjusted for demographic factors and other relevant disease-related variables. Interactions were explored to examine if indicators of kidney disease progression are associated with outcomes between the CAKUT and non-CAKUT groups. Results: The CAKUT sample (n=577) was generally younger (median age 8.7 years; interquartile range 4.7-12.8), had longer duration of CKD, and did not differ in baseline BASC-2 or BRIEF GEC scores compared to the non-CAKUT sample (n=540). Linear mixed model analyses show that duration of CKD was significantly associated with fewer internalizing (p< 0.0001), externalizing (p=0.001) symptoms, and lower adaptive skills (p< 0.0003), but not with executive functioning. Linear mixed model analyses showed a significant interaction of CAKUT status and urine protein/creatinine (uP/C) ratio, such that only children with CAKUT demonstrated an association between higher uP/C levels and greater executive functioning problems, internalizing symptoms, and lower adaptive skills (BRIEF GEC: ß=0.64; 95% CI, 0.07 to 1.20 p< 0.03; BASC-2 Internalizing: ß=0.60; 95% CI, 0.02 to 1.18 p< 0.04; BASC-2 ADAPTIVE: ß=-0.67; 95% CI, -1.19 to -0.15, p< 0.01).
Conclusion(s): Findings suggest that children with CAKUT generally do not differ from other children with CKD on parent-reported neuro/psychological function. However, a subset of children with CAKUT and poorly controlled uP/C may be at higher risk for parent-reported executive dysfunction, depression, and lower adaptive skills compared to children with CKD from other causes. These children may benefit from screening and, if indicated, referral to a psychologist for further assessment and behavioral health supports.
