Abstract

Research Article

Neurocognitive and Adaptive Functioning in Young Patients with Severe Chronic Kidney Disease

Sophie Lijdsman*, Jasmijn Kerklaan, Lotte Haverman, Marit S van Sandwijk, Antonia H Bouts, Koen van Hoeck, Huib de Jong, Frederike J Bemelman, Allison Jaure, Jaap W Groothoff and Kim J Oostrom

Published: 11 June, 2024 | Volume 8 - Issue 2 | Pages: 078-087

Background: To assess the association between neurocognitive functioning, adaptive functioning, and health-related quality of life (HRQoL), in Children and Young Adults with Severe Chronic Kidney Disease (CKD).
Methods: We included patients with severe CKD (stages 4 and 5), aged 8-30 years, on different therapy modalities (pre-dialysis, dialysis, and transplanted) and healthy controls matched on age, sex, and parental education. All patients and healthy controls performed tasks to assess neurocognitive functioning (WISC/WAIS and a comprehensive neuropsychological test battery), and completed questionnaires to assess adaptive functioning (WFIRS or WHODAS) and HRQoL (PedsQL). Group differences were explored using MANCOVA. Mediation analyses were done to explore whether the relation between neurocognitive functioning and HRQoL was mediated by adaptive functioning. 
Results: 28 patients with severe CKD and 21 healthy matched controls were included. CKD patients had worse HRQoL (p < .001) than healthy controls. Adaptive functioning problems increased with age in the CKD patient group but not in the healthy control group (significant interaction effect: p = .024). Significant mediation effects were found, where impaired adaptive functioning mediated the relation between both low estimated Full Scale Intelligence Quotient (eFSIQ) and worse Processing Speed & Working Memory, and impaired HRQoL (eFSIQ: 95% confidence interval = .01-.58; Processing Speed & Working Memory: 95% confidence interval = 2.31-16.36).
Conclusion: We found that impaired neurocognitive functioning is associated with worse HRQoL, which is conditional to impaired adaptive functioning. Especially towards young adulthood problems in adaptive functioning are more likely to be reported than when patients are younger.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001131 Cite this Article Read Full Article PDF

Keywords:

Cognition; Adaptation; Chronic kidney disease; Quality of life; Adolescents, Kidney failure; Kidney replacement therapy

References

  1. Lijdsman S, Oostrom KJ, van Sandwijk MS, Bouts AH, van Hoeck K, de Jong H, Oosterlaan J, Bemelman FJ, Königs M, Groothoff JW. Risk factors for neurocognitive impairment and the relation with structural brain abnormality in children and young adults with severe chronic kidney disease. Pediatr Nephrol. 2023 Jun;38(6):1957-1969. doi: 10.1007/s00467-022-05781-1. Epub 2022 Nov 2. PMID: 36322259; PMCID: PMC10154258.
  2. Lijdsman S, Königs M, van Sandwijk MS, Bouts AH, van Hoeck K, de Jong H, Engelen M, Oosterlaan J, Bemelman FJ, Oostrom KJ, Groothoff JW. Structural brain abnormalities in children and young adults with severe chronic kidney disease. Pediatr Nephrol. 2022 May;37(5):1125-1136. doi: 10.1007/s00467-021-05276-5. Epub 2021 Nov 20. PMID: 34800137; PMCID: PMC9023396.
  3. Groothoff JW, Grootenhuis M, Dommerholt A, Gruppen MP, Offringa M, Heymans HS. Impaired cognition and schooling in adults with end stage renal disease since childhood. Arch Dis Child. 2002 Nov;87(5):380-5. doi: 10.1136/adc.87.5.380. PMID: 12390905; PMCID: PMC1763100.
  4. Chen K, Didsbury M, van Zwieten A, Howell M, Kim S, Tong A, Howard K, Nassar N, Barton B, Lah S, Lorenzo J, Strippoli G, Palmer S, Teixeira-Pinto A, Mackie F, McTaggart S, Walker A, Kara T, Craig JC, Wong G. Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol. 2018 Mar 7;13(3):387-397. doi: 10.2215/CJN.09650917. Epub 2018 Feb 22. PMID: 29472306; PMCID: PMC5967677.
  5. Duquette PJ, Hooper SR, Wetherington CE, Icard PF, Gipson DS. Brief report: intellectual and academic functioning in pediatric chronic kidney disease. J Pediatr Psychol. 2007 Sep;32(8):1011-7. doi: 10.1093/jpepsy/jsm036. Epub 2007 Jun 7. PMID: 17556399.
  6. Vanderlinden JA, Ross-White A, Holden R, Shamseddin MK, Day A, Boyd JG. Quantifying cognitive dysfunction across the spectrum of end-stage kidney disease: A systematic review and meta-analysis. Nephrology (Carlton). 2019 Jan;24(1):5-16. doi: 10.1111/nep.13448. PMID: 30094890.
  7. Hooper SR, Laney N, Radcliffe J, Moodalbail D, Hartung EA, Ruebner RL, Jawad AF, Furth SL. Executive Functioning in Children, Adolescents, and Young Adults with Chronic Kidney Disease. J Dev Behav Pediatr. 2015 Nov-Dec;36(9):734-42. doi: 10.1097/DBP.0000000000000221. PMID: 26468938.
  8. Mendley SR, Matheson MB, Shinnar S, Lande MB, Gerson AC, Butler RW, Warady BA, Furth SL, Hooper SR. Duration of chronic kidney disease reduces attention and executive function in pediatric patients. Kidney Int. 2015 Apr;87(4):800-6. doi: 10.1038/ki.2014.323. Epub 2014 Sep 24. PMID: 25252026; PMCID: PMC4372504.
  9. Gerson AC, Wentz A, Abraham AG, Mendley SR, Hooper SR, Butler RW, Gipson DS, Lande MB, Shinnar S, Moxey-Mims MM, Warady BA, Furth SL. Health-related quality of life of children with mild to moderate chronic kidney disease. Pediatrics. 2010 Feb;125(2):e349-57. doi: 10.1542/peds.2009-0085. Epub 2010 Jan 18. PMID: 20083528; PMCID: PMC3663134.
  10. Tong A, Tjaden L, Howard K, Wong G, Morton R, Craig JC. Quality of life of adolescent kidney transplant recipients. J Pediatr. 2011 Oct;159(4):670-5.e2. doi: 10.1016/j.jpeds.2011.04.007. Epub 2011 May 31. PMID: 21621222.
  11. Lande MB, Gerson AC, Hooper SR, Cox C, Matheson M, Mendley SR, Gipson DS, Wong C, Warady BA, Furth SL, Flynn JT. Casual blood pressure and neurocognitive function in children with chronic kidney disease: a report of the children with chronic kidney disease cohort study. Clin J Am Soc Nephrol. 2011 Aug;6(8):1831-7. doi: 10.2215/CJN.00810111. Epub 2011 Jun 23. PMID: 21700829; PMCID: PMC3156422.
  12. Haavisto A, Korkman M, Holmberg C, Jalanko H, Qvist E. Neuropsychological profile of children with kidney transplants. Nephrol Dial Transplant. 2012 Jun;27(6):2594-601. doi: 10.1093/ndt/gfr650. Epub 2011 Dec 1. PMID: 22140125.
  13. Hooper SR, Gerson AC, Johnson RJ, Mendley SR, Shinnar S, Lande MB, Matheson MB, Gipson DS, Morgenstern B, Warady BA, Furth SL. Neurocognitive, Social-Behavioral, and Adaptive Functioning in Preschool Children with Mild to Moderate Kidney Disease. J Dev Behav Pediatr. 2016 Apr;37(3):231-8. doi: 10.1097/DBP.0000000000000267. PMID: 26890559; PMCID: PMC4818179.
  14. Thys K, Schwering KL, Siebelink M, Dobbels F, Borry P, Schotsmans P, Aujoulat I; ELPAT Pediatric Organ Donation and Transplantation Working Group. Psychosocial impact of pediatric living-donor kidney and liver transplantation on recipients, donors, and the family: a systematic review. Transpl Int. 2015 Mar;28(3):270-80. doi: 10.1111/tri.12481. Epub 2014 Nov 21. PMID: 25363518.
  15. Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol. 2016 Oct;31(10):1579-91. doi: 10.1007/s00467-015-3186-3. Epub 2015 Aug 27. PMID: 26310616; PMCID: PMC4995226.
  16. Lopes M, Ferraro A, Koch VH. Health-related quality of life of children and adolescents with CKD stages 4-5 and their caregivers. Pediatr Nephrol. 2014 Jul;29(7):1239-47. doi: 10.1007/s00467-014-2769-8. Epub 2014 Feb 28. PMID: 24577804.
  17. Moreira JM, Bouissou Morais Soares CM, Teixeira AL, Simões E Silva AC, Kummer AM. Anxiety, depression, resilience and quality of life in children and adolescents with pre-dialysis chronic kidney disease. Pediatr Nephrol. 2015 Dec;30(12):2153-62. doi: 10.1007/s00467-015-3159-6. Epub 2015 Jul 27. PMID: 26210984.
  18. Tong A, Henning P, Wong G, McTaggart S, Mackie F, Carroll RP, Craig JC. Experiences and perspectives of adolescents and young adults with advanced CKD. Am J Kidney Dis. 2013 Mar;61(3):375-84. doi: 10.1053/j.ajkd.2012.09.024. Epub 2013 Jan 10. PMID: 23312724.
  19. Tong A, Wong G, McTaggart S, Henning P, Mackie F, Carroll RP, Howard K, Craig JC. Quality of life of young adults and adolescents with chronic kidney disease. J Pediatr. 2013 Oct;163(4):1179-85.e5. doi: 10.1016/j.jpeds.2013.04.066. Epub 2013 Jun 22. PMID: 23800404.
  20. Varni JW, Limbers CA, Burwinkle TM. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes. 2007 Jul 16;5:43. doi: 10.1186/1477-7525-5-43. PMID: 17634123; PMCID: PMC1964786.
  21. King TZ, Ailion AS, Fox ME, Hufstetler SM. Neurodevelopmental model of long-term outcomes of adult survivors of childhood brain tumors. Child Neuropsychol. 2019 Jan;25(1):1-21. doi: 10.1080/09297049.2017.1380178. Epub 2017 Sep 28. PMID: 28956496.
  22. Wolfe KR, Madan-Swain A, Kana RK. Executive dysfunction in pediatric posterior fossa tumor survivors: a systematic literature review of neurocognitive deficits and interventions. Dev Neuropsychol. 2012;37(2):153-75. doi: 10.1080/87565641.2011.632462. PMID: 22339228; PMCID: PMC3730812.
  23. Tassé MJ. Adaptive behavior and functional life skills across the lifespan: Conceptual and measurement issues. Adaptive Behavior Strategies for Individuals with Intellectual and Developmental Disabilities: Evidence-Based Practices Across the Life Span: Springer; 2021; 1-20.
  24. Alhamed AA, Toly VB, Hooper SR, Dell KM. The link between executive function, socio-emotional functioning and health-related quality of life in children and adolescents with mild to moderate chronic kidney disease. Child Care Health Dev. 2022 May;48(3):455-464. doi: 10.1111/cch.12946. Epub 2021 Dec 16. PMID: 34893999.
  25. Valderas JM, Alonso J. Patient reported outcome measures: a model-based classification system for research and clinical practice. Qual Life Res. 2008 Nov;17(9):1125-35. doi: 10.1007/s11136-008-9396-4. Epub 2008 Oct 3. PMID: 18836850.
  26. Organization WH. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY: World Health Organization; 2007.
  27. Kerklaan J, Hannan E, Hanson C, Guha C, Cho Y, Christian M, Hamiwka L, Ryan J, Sinha A, Wong G, Craig J, Groothoff J, Tong A. Perspectives on life participation by young adults with chronic kidney disease: an interview study. BMJ Open. 2020 Oct 16;10(10):e037840. doi: 10.1136/bmjopen-2020-037840. PMID: 33067282; PMCID: PMC7569939.
  28. Stewart AJ, Sokol M, Healy JM, Chester NL. Longitudinal studies of psychological consequences of life changes in children and adults. Journal of Personality and Social Psychology. 1986; 50(1):143.
  29. Stewart JL. Children living with chronic illness: an examination of their stressors, coping responses, and health outcomes. Annu Rev Nurs Res. 2003;21:203-43. PMID: 12858698.
  30. Groothoff JW, Grootenhuis MA, Offringa M, Gruppen MP, Korevaar JC, Heymans HS. Quality of life in adults with end-stage renal disease since childhood is only partially impaired. Nephrol Dial Transplant. 2003 Feb;18(2):310-7. doi: 10.1093/ndt/18.2.310. PMID: 12543886.
  31. Kim WS, Cho SI, Shin HI, Park JH. Identifying factors associated with self-rated health according to age at onset of disability. Disabil Rehabil. 2012;34(15):1262-70. doi: 10.3109/09638288.2011.641656. Epub 2011 Dec 26. PMID: 22200125.
  32. Carr AJ, Gibson B, Robinson PG. Measuring quality of life: Is quality of life determined by expectations or experience? BMJ. 2001 May 19;322(7296):1240-3. doi: 10.1136/bmj.322.7296.1240. PMID: 11358783; PMCID: PMC1120338.
  33. Allen TM, Anderson LM, Rothman JA, Bonner MJ. [Formula: see text]Executive functioning and health-related quality of life in pediatric sickle cell disease. Child Neuropsychol. 2017 Nov;23(8):889-906. doi: 10.1080/09297049.2016.1205011. Epub 2016 Jul 21. PMID: 27439898.
  34. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995 Jan 4;273(1):59-65. PMID: 7996652.
  35. Levin A, Stevens P, Bilous RW, Coresh J, Francisco A, Jong PE, et al. Kidney disease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements. 2013;3:1-150.
  36. Haverman L, van Rossum MA, van Veenendaal M, van den Berg JM, Dolman KM, Swart J, Kuijpers TW, Grootenhuis MA. Effectiveness of a web-based application to monitor health-related quality of life. Pediatrics. 2013 Feb;131(2):e533-43. doi: 10.1542/peds.2012-0958. Epub 2013 Jan 6. PMID: 23296436.
  37. Onderwijsindeling S. Standard Educational Classification. Den Haag/Heerlen: Centraal Bureau voor de Statistiek [Statistics Netherlands]. 2016.
  38. Kaldenbach Y. De WISC-III anno 2006. Kind & Adolescent Praktijk. 2006;5(3):100.
  39. Gajria K, Kosinski M, Sikirica V, Huss M, Livote E, Reilly K, Dittmann RW, Erder MH. Psychometric validation of the Weiss Functional Impairment Rating Scale-Parent Report Form in children and adolescents with attention-deficit/hyperactivity disorder. Health Qual Life Outcomes. 2015 Nov 17;13:184. doi: 10.1186/s12955-015-0379-1. PMID: 26577642; PMCID: PMC4650258.
  40. Weiss MD, McBride NM, Craig S, Jensen P. Conceptual review of measuring functional impairment: findings from the Weiss Functional Impairment Rating Scale. Evid Based Ment Health. 2018 Nov; 21(4):155-164. doi: 10.1136/ebmental-2018-300025. Epub 2018 Oct 12. PMID: 30314990; PMCID: PMC6241626.
  41. Organisation WH. Measuring health and disability: manual for WHO Disability Assessment Schedule (‎WHODAS 2.0)‎. 2010. Contract No.: ISBN: 9789241547598.
  42. Hope TL, Adams C, Reynolds L, Powers D, Perez RA, Kelley ML. Parent vs. self-report: Contributions toward diagnosis of adolescent psychopathology. Journal of Psychopathology and Behavioral Assessment. 1999; 21:349-63.
  43. Phares V, Compas BE, Howell DC. Perspectives on child behavior problems: Comparisons of children's self-reports with parent and teacher reports. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989; 1(1):68.
  44. Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care. 1999 Feb;37(2):126-39. doi: 10.1097/00005650-199902000-00003. PMID: 10024117.
  45. Varni JW, Limbers CA, Burwinkle TM. How young can children reliably and validly self-report their health-related quality of life?: an analysis of 8,591 children across age subgroups with the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes. 2007 Jan 3;5:1. doi: 10.1186/1477-7525-5-1. PMID: 17201920; PMCID: PMC1769360.
  46. van Muilekom MM, Luijten MAJ, van Oers HA, Conijn T, Maurice-Stam H, van Goudoever JB, Grootenhuis MA, Haverman L; KLIK collaborator group. Paediatric patients report lower health-related quality of life in daily clinical practice compared to new normative PedsQLTM Acta Paediatr. 2021 Jul;110(7):2267-2279. doi: 10.1111/apa.15872. Epub 2021 May 6. PMID: 33838052; PMCID: PMC8360011.
  47. Engelen V, Haentjens MM, Detmar SB, Koopman HM, Grootenhuis MA. Health related quality of life of Dutch children: psychometric properties of the PedsQL in the Netherlands. BMC Pediatr. 2009 Nov 3;9:68. doi: 10.1186/1471-2431-9-68. PMID: 19887000; PMCID: PMC2776579.
  48. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach: Guilford publications; 2017.
  49. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009 Mar;20(3):629-37. doi: 10.1681/ASN.2008030287. Epub 2009 Jan 21. PMID: 19158356; PMCID: PMC2653687.
  50. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, Van Lente F; Chronic Kidney Disease Epidemiology Collaboration. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem. 2007 Apr;53(4):766-72. doi: 10.1373/clinchem.2006.077180. Epub 2007 Mar 1. PMID: 17332152.
  51. Okuda Y, Soohoo M, Tang Y, Obi Y, Laster M, Rhee CM, Streja E, Kalantar-Zadeh K. Estimated GFR at Dialysis Initiation and Mortality in Children and Adolescents. Am J Kidney Dis. 2019 Jun;73(6):797-805. doi: 10.1053/j.ajkd.2018.12.038. Epub 2019 Mar 2. PMID: 30833086.
  52. Love CE, Webbe F, Kim G, Lee KH, Westerveld M, Salinas CM. The role of executive functioning in quality of life in pediatric intractable epilepsy. Epilepsy Behav. 2016 Nov;64(Pt A):37-43. doi: 10.1016/j.yebeh.2016.08.018. Epub 2016 Oct 8. PMID: 27728901.
  53. Schraegle WA, Titus JB. Executive function and health-related quality of life in pediatric epilepsy. Epilepsy Behav. 2016 Sep;62:20-6. doi: 10.1016/j.yebeh.2016.06.006. Epub 2016 Jul 20. PMID: 27448239.
  54. Sherman EM, Slick DJ, Eyrl KL. Executive dysfunction is a significant predictor of poor quality of life in children with epilepsy. Epilepsia. 2006 Nov;47(11):1936-42. doi: 10.1111/j.1528-1167.2006.00816.x. PMID: 17116035.
  55. Ziengs AL, Buunk AM, van Sonderen L, Eisenga MF, Gomes Neto AW, Annema C, Vlagsma T, Navis GJ, Berger SP, Bakker SJL, Spikman JM. Long-term cognitive impairments in kidney transplant recipients: impact on participation and quality of life. Nephrol Dial Transplant. 2023 Feb 13;38(2):491-498. doi: 10.1093/ndt/gfac035. PMID: 35175356; PMCID: PMC9923696.
  56. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986 Dec;51(6):1173-82. doi: 10.1037//0022-3514.51.6.1173. PMID: 3806354.
  57. Sikora DM, Vora P, Coury DL, Rosenberg D. Attention-deficit/hyperactivity disorder symptoms, adaptive functioning, and quality of life in children with autism spectrum disorder. Pediatrics. 2012 Nov;130 Suppl 2:S91-7. doi: 10.1542/peds.2012-0900G. PMID: 23118259.
  58. Al Shahawy AK, El-Gamasy MA, Elhakeem Seleem MA, Mawlana W, El Sharkaway AH. Assessment of cognitive functions and adaptive behavior in children with end-stage renal disease on regular hemodialysis. Saudi J Kidney Dis Transpl. 2020 Mar-Apr;31(2):395-406. doi: 10.4103/1319-2442.284014. PMID: 32394912.
  59. Knight A, Kogon AJ, Matheson MB, Warady BA, Furth SL, Hooper SR. Cognitive Function in Children with Lupus Nephritis: A Cross-Sectional Comparison with Children with Other Glomerular Chronic Kidney Diseases. J Pediatr. 2017 Oct;189:181-188.e1. doi: 10.1016/j.jpeds.2017.06.044. Epub 2017 Jul 19. PMID: 28734655; PMCID: PMC5614831.
  60. Anderson P. Assessment and development of executive function (EF) during childhood. Child Neuropsychol. 2002 Jun;8(2):71-82. doi: 10.1076/chin.8.2.71.8724. PMID: 12638061.

Figures:

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?