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Indicator Details — Children and Adolescents: eGFR and Neurocognitive Performance in Children and Young Adults with CKDa
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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

Footnotes:
a The p-values for the attention, visual spatial, and visual working memory domains are 0.02, 0.02, and 0.04, respectively.




A lower estimated glomerular filtration rate (eGFR) was associated with poorer neurocognitive performance in children with CKD. As eGFR decreased, there was a trend towards poorer performance in the eleven neurocognitive domains assessed. Children and young adults with a lower eGFR performed significantly worse in areas of attention (β = 0.053, p= 0.02), visual spatial skills (β = 0.062, p= 0.02), and visual working memory (β = 0.069, p= 0.04).
 
Chart Explanation: 
A multivariable linear regression analysis was performed to assess the effect of worsening kidney function on neurocognitive performance in children and young adults. A lower eGFR was associated with poorer neurocognitive performance in children and young adults with CKD. As eGFR decreased, there was a trend towards poorer performance in the 11 neurocognitive domains assessed. Children and young adults with a lower eGFR performed significantly worse in areas of attention (β = 0.053, p= 0.02), visual spatial skills (β = 0.062, p= 0.02), and visual working memory (β = 0.069, p= 0.04). All results were adjusted for demographic and clinical factors. The β coefficients (95% confidence interval) indicate the difference in domain z-score per 10-unit higher eGFR. The Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease (NiCK) study cohort comprises 90 individuals with CKD who were aged 8 to 25 years. Individuals were recruited from the Philadelphia area.
The Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease (NiCK) study is a cross-sectional cohort study involving children and young adults, aged 8 to 25 years. The study compares the neurological function of those with CKD to those without CKD, with the goal of identifying any neurological abnormalities in the CKD population. The study assessment involves neurocognitive testing, clinical phenotyping, multimodal magnetic resonance imaging (MRI) of the brain, functional connectivity, and blood flow. Participants were included in the CKD group if they had 2 estimated glomerular filtration rates (eGRFs) less than 90 mL/min/1.73 m2 over at least 6 months. Participants could qualify for the CKD group regardless of whether they had received a transplant or were on dialysis. All study participants spoke English as their primary language. Control participants were recruited from pediatric practices in the Children's Hospital of Philadelphia network.
 

This indicator is based on analysis in published literature: Ruebner RL, Laney N, Kim JY, et al. Neurocognitive Dysfunction in Children, Adolescents, and Young Adults With CKD. Am J Kidney Dis. 2016;67(4):567-575.
http://www.ncbi.nlm.nih.gov/pubmed/26476795
FieldData
Description of MeasureNeurocognitive performance in children with CKD
Data SourceNeurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease (NiCK) Study
Type of Data SourceCross-sectional cohort study
Data SetThe Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease (NiCK) study is a cross-sectional cohort study involving children and young adults, aged 8 to 25 years from the Philadelphia area
Health Care Data SystemNo
Regional or National?Regional
Demographic GroupThe Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults With Chronic Kidney Disease (NiCK) Study included 90 individuals aged 8 to 25 years with CKD compared with 70 controls; all participants were from the Philadelphia area
NumeratorAll participants with CKD who underwent 24-hour ambulatory BP monitoring 
DenominatorAll participants who underwent 24-hour ambulatory BP monitoring 
Definition of CKDAt least 2 estimated glomerular filtration rates (eGFRs)< 90 mL/min/1.73 m2  over at least 6 months; included individuals who were currently or previously on dialysis therapy or had a functioning transplant
Glomerular Filtration RateCalculated using the bedside CKD in Children (CKiD) equation for individuals aged 8 to 18 years and the 4-variable MDRD (Modification of Diet in Renal Disease) Study equation for those older than 18 years
Primary Data Source IndicatorNeurocognitive function
Primary Indicator Method of MeasurementA battery of age-specific standardized neurocognitive assessments was performed to assess targeted areas of neurocognition, including executive functioning, attention, memory, and visual spatial processing. All tests were administered by a trained examiner supervised by a licensed psychologist.
Secondary Data Source IndicatoreGFR function
Secondary Indicator Method of MeasurementeGFR values recorded in medical record
Frequency of MeasurementOnce
Period Currently Available2014
Pending DataNone
U.S. Region Covered by Primary VariablePhiladelphia area
Additional Data Items of InterestCause of CKD, income, insurance, age, sex, race, BP
Limitations of IndicatorCross-sectional nature of the study meant that investigators could not assess changes in neurocognitive function that might be linked to changes in kidney function; small sample size
Analytical ConsiderationsAs with all cohort studies, selection bias and possible confounding
References and Sources:

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd