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Kidney Week

Abstract: TH-OR127

Sleep Problems and Fatigue and Their Relationships with Emotional-Behavioral Symptoms and Neurocognitive Outcomes in Pediatric CKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology


  • Johnson, Rebecca J., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Matheson, Matthew, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Harshman, Lyndsay, University of Iowa Children's Hospital, Iowa City, Iowa, United States
  • Gerson, Arlene C., Johns Hopkins School of Medicine, Baltimore, Maryland, United States
  • Kogon, Amy, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania, United States
  • Lande, Marc, University of Rochester Medical Center, Rochester, New York, United States
  • Shinnar, S., Montefiore Medical Center, Albert EInstein College of MEdicine, Bronx, New York, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania, United States
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Hooper, Stephen R., University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States

Children with CKD are at risk for deficits in neurocognitive function. It is not known how sleep problems/fatigue within the context of CKD may contribute to these deficits.


Data from the Chronic Kidney Disease in Children (CKiD) study was used to evaluate the prevalence of sleep problems/fatigue among children with mild to moderate CKD, and to examine whether sleep problems or fatigue predict neurocognitive or emotional-behavioral outcomes. Four variables were created: fatigue, sleep disturbance, low energy, and trouble sleeping. Linear mixed models were used to determine if fatigue or sleep problems were associated with neurocognitive and emotional-behavioral outcomes. Each model was adjusted for sociodemographic and disease-related covariates.


Baseline data was available for 1030 participants (median disease duration 6 years; 63% male; mean eGFR was 53 ml/min|1.73m2). Prevalence was 26% (fatigue), 30% (sleep disturbance), 52% (low energy), 39% (trouble sleeping). Sleep disturbance (β=1.28, CI=0.25, 2.32; p=.02), low energy (β=1.85, CI=0.79, 2.9; p=.0006), and trouble sleeping (β=1.87, CI=0.87, 2.87; p=.0003) were significantly associated with worse parent ratings of overall executive functions. Low energy was significantly associated with lower working memory (Digit Span Forward β=-0.37, CI=-0.72, -0.01, p=.05; Digit Span Backward β=-0.48, CI=-0.87, -0.09, p=.02). Low energy was significantly associated with lower inhibition (B=-0.92, CI=1.57, -0.28, p=.0006) and lower problem-solving B=-0.67, CI=-1.25, -0.09, p=.02). Each of the four sleep measures was significantly related to more internalizing symptoms on a measure of emotional-behavioral functioning, and sleep disturbance, low energy, and trouble sleeping were associated with more externalizing symptoms.


A significant proportion of children with CKD report fatigue and problems with sleep. Sleep problems and fatigue were associated with lower executive functioning and increased emotional-behavioral symptoms over time after adjusting for key sociodemographic and CKD-related covariates. Assessing sleep problems/fatigue and treating co-morbidities may promote more positive emotional-behavioral and neurocognitive outcomes for children with CKD.


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