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Abstract: PO1976

The Effect of Anemia on Neurocognition in Children with CKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Carlson, Joann M., Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, United States
  • Matheson, Matthew, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Manne, Sharon L., Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, United States
  • Jones, Erin Marie, Emory University School of Medicine, Atlanta, Georgia, United States
  • Harshman, Lyndsay, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
  • Johnson, Rebecca J., University of Missouri Kansas City School of Medicine, Kansas City, Missouri, United States
  • Wong, Cynthia, Stanford University School of Medicine, Stanford, California, United States
  • Kogon, Amy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Jerry-Fluker, Judith, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Lande, Marc, University of Rochester Medical Center, Rochester, New York, United States
  • Warady, Bradley A., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Hooper, Stephen R., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
Background

Chronic kidney disease (CKD) has been shown to affect neurocognitive outcomes. Anemia is associated with CKD and has been associated with a decrease in neurocognition in adults with CKD. Few studies have looked at neurocognitive outcomes in children with both CKD and anemia. This study’s purpose is to evaluate the impact of anemia on neurocognition in children with mild to moderate CKD.

Methods

Participants were > 7 y and in the Chronic Kidney Disease in Children Study (CKiD) with NIH Cognitive Toolbox data. Anemia was defined as hemoglobin < 5th percentile for age, sex and race or use of an Erythropoietin-Stimulating Agent. All outcomes were compared between anemic and non-anemic groups descriptively using box plots, t-tests, and the magnitude of differences using Cohen’s U3 statistic for effect size. Inverse probability weighting (IPW) was used to align the non-anemic and anemic groups on sex, estimated GFR level, urine protein/creatinine ratio, disease etiology, seizure history, hypertension and maternal education.

Results

87 subjects total (25% with anemia) met criteria. Prior to weighting, groups were similar in age (17.9 vs 17.1 y, anemic vs non-anemic) with the anemic group trending towards a higher male percentage (73 vs 52%), and lower baseline eGFR (42 vs 64 ml/min|1.73m2). In the descriptive analysis, box plots displayed that anemic patients had a tendency towards lower scores than non-anemic patients. In the IPW-weighted analysis, subjects who were anemic were found to have worse Picture Vocabulary (U3=+23), Crystallized Cognition (U3=+22) and Total Cognition (U3=+19), but better Pattern Comparison (U3=-35), Working Memory (U3=-22) and Fluid Cognition (U3=-22). However, using the t-test, only Picture Vocabulary (p=0.02) and Crystallized Cognition Composite (p=0.03) were significantly different between the groups, with the anemic group performing more poorly than the non-anemic group.

Conclusion

Children with CKD and anemia had significantly lower scores on Picture Vocabulary and on the Crystallized Cognition Composite compared to non-anemic patients after adjusting for covariates, with moderate to large effect sizes. These results suggest that anemia may be a modifiable determinant of cognitive outcomes in children with CKD.

Funding

  • NIDDK Support