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Abstract: SA-PO378

Cognitive and Social Functioning of Infants and Preschoolers with Mild to Moderate CKD

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Hooper, Stephen R., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Johnson, Rebecca J., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Lande, Marc, University of Rochester Medical Center, Rochester, New York, United States
  • Harshman, Lyndsay, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Bartosh, Sharon M., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Wong, Cynthia, Stanford University School of Medicine, Stanford, California, United States
  • Carlson, Joann M., Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, United States
  • Wilson, Camille, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Dawson, Anne E., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Molitor, Stephen J., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Matheson, Matthew, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Group or Team Name

  • CKiD Study.
Background

Previously published data from the observational CKiD Study showed average neurocognitive function for a combined sample of infants and preschoolers with CKD, although 20% to 37% were deemed at-risk for selected neurodevelopmental difficulties (e.g., executive dysfunction). The current study expands upon previous findings with increased sample size and the examination of infants separately from preschool-age children.

Methods

Participants were 38 infants (Mean age=1.8 yrs) and 225 preschoolers (Mean age=4.8 yrs) recruited by CKiD Study sites. Infants were 76% male, with a median eGFR=49; preschoolers were 73% male, with a median eGFR=53. Measures included the Mullen Scales of Early Learning for infants, and the Wechsler Preschool and Primary Scale of Intelligence IV (WPPSI-IV) for preschoolers. Participants across both age bands received the parent-completed Ages & Stages Questionnaire: Social Emotional (ASQ:SE). Covariates included age, sex, maternal education, eGFR, hypertension, anemia/ESA use, proteinuria, seizure history, and abnormal birth history. Multivariate and logistic regressions were employed.

Results

After adjustment for covariates, infant Mullen Receptive Language (p=.02) and Expressive Language (p=.03) scores dropped with every 10% decline in eGFR. For the preschoolers, a 10% decline in eGFR (p=.004) and a doubling of proteinuria (p=.0002) were each associated with lower WPPSI-IV Verbal IQ. On the parent-completed ASQ:SE for the combined sample, about 13% were deemed at-risk for social-emotional problems, although the doubling of proteinuria was associated with at-risk status (p=.01).

Conclusion

CKD progression was associated with lower language-related abilities for infants and preschoolers, and this represents a novel finding in the CKD neurodevelopmental literature. The rate of parental concerns for social-emotional difficulties was equivalent to what might be expected in the typical population, although the doubling of proteinuria was associated with at-risk social status. Results highlight the need for early identification and ongoing developmental surveillance of young children with mild to moderate CKD, with further attention being devoted to early language and social development.

Funding

  • NIDDK Support