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Mathew J, Tumin D, Beng-Ongey H. Predictors of academic delay post-pediatric kidney transplant in the USA. Pediatr Nephrol 2024:10.1007/s00467-024-06445-y. [PMID: 38963554 DOI: 10.1007/s00467-024-06445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Pediatric patients with kidney failure often experience cognitive delays. However, academic delay (being more than one grade level below age-appropriate grade, or in special education) after pediatric kidney transplantation (KTx) has not been explored. We sought to identify patient characteristics associated with a higher risk of academic delay 1 year post-KTx. METHODS We used the United Network for Organ Sharing (UNOS) database to identify children aged 6-17 years who received a primary KTx between 2014 and 2021 and had a functioning graft 1 year after KTx. The primary outcome was the patient's academic progress at 1 year post-transplant. The secondary outcome was change in academic progress between transplant and 1-year follow-up: onset of new delay, resolution of pre-existing delay, persistence of delay, or no delay at either timepoint. Binomial and multinomial mixed effects logistic regression models were used to predict each outcome based on patient characteristics. RESULTS The study included 2197 patients, of whom 14% demonstrated academic delay at 1 year post-KTx, 4% demonstrated a new onset of academic delay, 5% demonstrated a resolution of academic delay, and 10% demonstrated persistent academic delay. Patients undergoing transplantation at a younger age, receiving a deceased donor kidney, experiencing longer waitlist times, and undergoing KTx for vascular or other disease indications for KTx were more likely to experience academic delays, including new-onset academic delays. CONCLUSIONS Academic delays are frequently reported among pediatric KTx recipients. Additional academic support may help resolving or preventing academic delay for at-risk subgroups of children undergoing KTx.
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Affiliation(s)
- Joanna Mathew
- East Carolina University, E 5thSt, Greenville, NC, 27858, USA.
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
- Department of Academic Affairs, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Hostensia Beng-Ongey
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
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Richardson K, Ward RC, Harshman LA. Education and employment outcomes in pediatric chronic kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06431-4. [PMID: 38940923 DOI: 10.1007/s00467-024-06431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/09/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024]
Abstract
As outcomes and survival for children with chronic kidney disease (CKD) have improved over the last 30 years, there is an emerging need to characterize and understand later educational and employment outcomes across the spectrum of pediatric CKD severity-ranging from mild CKD to requirement for dialysis and kidney transplantation. Although large-scale research on the topic of long-term educational and employment outcomes in the pediatric CKD population is relatively scarce, the existing literature does support that children across the spectrum of CKD severity are at risk for education-related difficulties including chronic school absenteeism. These education-related difficulties are compounded by well-described neurocognitive deficits-particularly in the domain of executive functioning-that may potentially perpetuate the risk for academic underachievement. This is particularly concerning given that data from the general pediatric population suggest that childhood academic underachievement is associated with higher likelihood of un-/underemployment in adulthood. This review highlights what is known about educational and employment outcomes among persons with a history of childhood CKD, as well as suggestions for interventions to improve educational outcomes for this population.
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Affiliation(s)
- Kelsey Richardson
- Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, USA.
| | - Ryan C Ward
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Lyndsay A Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Munshi R, Torres AH, Ramirez-Preciado B, Reyes LJC, Richardson T, Pruette CS. Transition of care: lessons from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) dialysis collaborative. Pediatr Nephrol 2024; 39:1551-1557. [PMID: 38085355 DOI: 10.1007/s00467-023-06244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND Acknowledging the importance of preparing the pediatric dialysis patient for successful transfer to adult providers, centers from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Dialysis Collaborative developed transition tools and performed iterative implementation of a transition of care (TOC) program to gain real-life insight into drivers and barriers towards implementation of a transition program for patients receiving dialysis. METHODS A TOC innovation workgroup was developed in 2019 from within SCOPE Collaborative that developed nine educational modules, along with introductory letter and assessment tool to be utilized by SCOPE centers. A 4-month pilot implementation study among six centers of varying patient population (age ≥ 11 years) was performed. TOC tools were further refined, and broader implementation within the collaborative was performed. Interim assessment of TOC tool utilization and implementation success was performed among 11 centers, as a foundation towards broader discussion regarding process, barriers, and success towards TOC implementation among 26 centers. RESULTS Transition champion was a key driver of successful implementation, and lack of institutional support and collaboration with adult dialysis centers were important barriers towards sustainability. COVID pandemic and increased staff turnover affected longer term implementation of TOC program. CONCLUSIONS Successful transition and transfer of adolescents/young adults with kidney failure on dialysis remains a challenge. This study represents the experience of the largest cohort of pediatric dialysis centers, with diversity in population size and geography, towards development and implementation of a TOC program. This adds to the resources available to assist centers towards transition and transfer, with particular focus on transitioning patients on dialysis.
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Affiliation(s)
- Raj Munshi
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
| | | | | | | | | | - Cozumel S Pruette
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
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van Zwieten A, Kim S, Dominello A, Guha C, Craig JC, Wong G. Socioeconomic Position and Health Among Children and Adolescents With CKD Across the Life-Course. Kidney Int Rep 2024; 9:1167-1182. [PMID: 38707834 PMCID: PMC11068961 DOI: 10.1016/j.ekir.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Children and adolescents in families of lower socioeconomic position (SEP) experience an inequitable burden of reduced access to healthcare and poorer health. For children living with chronic kidney disease (CKD), disadvantaged SEP may exacerbate their considerable disease burden. Across the life-course, CKD may also compromise the SEP of families and young people, leading to accumulating health and socioeconomic disadvantage. This narrative review summarizes the current evidence on relationships of SEP with kidney care and health among children and adolescents with CKD from a life-course approach, including impacts of family SEP on kidney care and health, and bidirectional impacts of CKD on SEP. It highlights relevant conceptual models from social epidemiology, current evidence, clinical and policy implications, and provides directions for future research. Reflecting the balance of available evidence, we focus primarily on high-income countries (HICs), with an overview of key issues in low- and middle-income countries (LMICs). Overall, a growing body of evidence indicates sobering socioeconomic inequities in health and kidney care among children and adolescents with CKD, and adverse socioeconomic impacts of CKD. Dedicated efforts to tackle inequities are critical to ensuring that all young people with CKD have the opportunity to live long and flourishing lives. To prevent accumulating disadvantage, the global nephrology community must advocate for local government action on upstream social determinants of health; and adopt a life-course approach to kidney care that proactively identifies and addresses unmet social needs, targets intervening factors between SEP and health, and minimizes adverse socioeconomic outcomes across financial, educational and vocational domains.
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Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Siah Kim
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Amanda Dominello
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Chandana Guha
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
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Turner EM, Cassidy AR, Rea KE, Smith-Paine JM, Wolfe KR. [Formula: see text] The multifaceted role of neuropsychology in pediatric solid organ transplant: preliminary guidelines and strategies for clinical practice. Child Neuropsychol 2024; 30:503-537. [PMID: 37291962 DOI: 10.1080/09297049.2023.2221759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
The incidence of pediatric solid organ transplantation (SOT) has increased in recent decades due to medical and surgical advances as well as improvements in organ procurement. Survival rates for pediatric kidney, liver, and heart transplantation are above 85% but patients continue to experience complex healthcare needs over their lifetime. Long-term developmental and neuropsychological sequelae are becoming increasingly recognized in this population, although preliminary work is limited and deserves further attention. Neuropsychological weaknesses are often present prior to transplantation and may be related to underlying congenital conditions as well as downstream impact of the indicating organ dysfunction on the central nervous system. Neuropsychological difficulties pose risk for functional complications, including disruption to adaptive skill development, social-emotional functioning, quality of life, and transition to adulthood. The impact of cognitive dysfunction on health management activities (e.g., medication adherence, medical decision-making) is also an important consideration given these patients' lifelong medical needs. The primary aim of this paper is to provide preliminary guidelines and clinical strategies for assessment of neuropsychological outcomes across SOT populations for pediatric neuropsychologists and the multidisciplinary medical team, including detailing unique and shared etiologies and risk factors for impairment across organ types, and functional implications. Recommendations for clinical neuropsychological monitoring as well as multidisciplinary collaboration within pediatric SOT teams are also provided.
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Affiliation(s)
- Elise M Turner
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam R Cassidy
- Departments of Psychiatry & Psychology and Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly E Rea
- Division of Pediatric Psychology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Julia M Smith-Paine
- Division of Developmental-Behavioral Pediatrics & Psychology, Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
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Mai K, Dawson AE, Gu L, LaMotte JE, Molitor S, Zimmerman CT. Common mental health conditions and considerations in pediatric chronic kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06314-8. [PMID: 38456918 DOI: 10.1007/s00467-024-06314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
The mental health of youth with chronic kidney disease (CKD) has been increasingly recognized as an area of clinical need. The development of mental health concerns is influenced by a range of physiological, psychological, and environmental factors. Some of these factors are common across child development, but some are more unique to youth with CKD. Mental health concerns are associated with increased risk for a range of poor medical outcomes (e.g., adherence, risk of transplant rejection) and quality of life concerns. In this educational review, we discuss the current evidence base regarding the development of mental health concerns in youth with CKD. The review covers multiple domains including mood and anxiety disorders, traumatic stress, and neurodevelopmental disorders. Estimated prevalence and hypothesized risk factors are outlined, and the potential impact of mental health on medical care and functional outcomes are reviewed. Finally, we introduce options for intervention to support positive mental health and offer recommendations for building access to mental health care and improving the mental health education/training of medical professionals.
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Affiliation(s)
- Katherine Mai
- Division of Pediatric Nephrology, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11364, USA.
| | - Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lidan Gu
- Division of Clinical Behavioral Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Julia E LaMotte
- Division of Child and Adolescent Psychiatry, Riley Children's Health, Indianapolis, IN, USA
| | - Stephen Molitor
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Cortney T Zimmerman
- Division of Psychology and Nephrology Service, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, 77030, USA
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Verhofste SL, Conrad AL, Johnson RJ, Steinbach EJ, Staber JM, Harshman LA. Self-concept and academic achievement in children with chronic kidney disease. Pediatr Nephrol 2024; 39:819-827. [PMID: 37594577 PMCID: PMC10999179 DOI: 10.1007/s00467-023-06106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Within the pediatric population, a positive self-concept is associated with better academic achievement. Children with chronic kidney disease (CKD) are at risk for lower quality of life and academic underachievement. Little is known about self-concept among children with CKD and how self-concept influences academic achievement. The objectives of the present study were to (1) describe patient-reported self-concept among children with CKD and (2) evaluate the relationship between self-concept and academic performance. METHODS This cross-sectional study included 23 children, aged 6-16 years, with mild to moderate CKD (cause of disease due to congenital anomalies of the kidney and urinary tract) and 26 age-matched comparators. Participants completed the Self-Description Questionnaire (SDQ) and the Wide Range Achievement Test (WRAT-4). Linear regression models were used to evaluate self-concept as a predictor of academic achievement in the CKD cohort. RESULTS Self-concept ratings were comparable between children with CKD and non-CKD comparators; however, academic achievement trended lower for the CKD patients on measures of arithmetic (estimate = - 0.278, 95% confidence interval (CI) [- 0.530: - 0.026], t(45) = - 1.99, p = 0.053). All of the SDQ domains predicted WRAT-4 arithmetic performance, such that higher scores on the SDQ were associated with higher scores in mathematics. Kidney function did not have an effect on the relationship between self-concept and academic achievement. CONCLUSIONS Despite the presence of a chronic disease, children with CKD endorse a positive self-concept. Positive self-concept may predict academic success in this population.
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Affiliation(s)
- Silvia L Verhofste
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Amy L Conrad
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Rebecca J Johnson
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, USA
| | - Emily J Steinbach
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Janice M Staber
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Lyndsay A Harshman
- Stead Family Department of Pediatrics, Division of Pediatric Nephrology, University of Iowa Carver College of Medicine, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA.
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Swanson MB, Weidemann DK, Harshman LA. The impact of rural status on pediatric chronic kidney disease. Pediatr Nephrol 2024; 39:435-446. [PMID: 37178207 PMCID: PMC10182542 DOI: 10.1007/s00467-023-06001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.
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Affiliation(s)
- Morgan Bobb Swanson
- Department of Epidemiology, College of Medicine and College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Darcy K Weidemann
- Department of Pediatrics, Section of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa, 425 General Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Lullmann O, van der Plas E, Harshman LA. Understanding the impact of pediatric kidney transplantation on cognition: A review of the literature. Pediatr Transplant 2023; 27:e14597. [PMID: 37664967 PMCID: PMC11034761 DOI: 10.1111/petr.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a relatively rare childhood disease that is associated with a wide array of medical comorbidities. Roughly half of all pediatric patients acquire CKD due to congenital anomalies of the kidneys and urinary tract, and of those with congenital disease, 50% will progress to end-stage kidney disease (ESKD) necessitating a kidney transplantation. The medical sequelae of advanced CKD/ESKD improve dramatically following successful kidney transplantation; however, the impact of kidney transplantation on neurocognition in children is less clear. It is generally thought that cognition improves following kidney transplantation; however, our knowledge on this topic is limited by the sparsity of high-quality data in the context of the relative rarity of pediatric CKD/ESKD. METHOD We conducted a narrative review to gauge the scope of the literature, using the PubMed database and the following keywords: cognition, kidney, brain, pediatric, neurocognition, intelligence, executive function, transplant, immunosuppression, and neuroimaging. RESULTS There are few published longitudinal studies, and existing work often includes wide heterogeneity in age at transplant, variable dialysis exposure/duration prior to transplant, and unaccounted cofounders which persist following transplantation, including socio-economic status. Furthermore, the impact of long-term maintenance immunosuppression on the brain and cognitive function of pediatric kidney transplant (KT) recipients remains unknown. CONCLUSION In this educational review, we highlight what is known on the topic of neurocognition and neuroimaging in the pediatric KT population.
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Affiliation(s)
- Olivia Lullmann
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
| | - Ellen van der Plas
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
- Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine; Little Rock, AR
| | - Lyndsay A. Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
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Harshman LA, Ward RC, Matheson MB, Dawson A, Kogon AJ, Lande MB, Molitor SJ, Johnson RJ, Wilson C, Warady BA, Furth SL, Hooper SR. The Impact of Pediatric CKD on Educational and Employment Outcomes. KIDNEY360 2023; 4:1389-1396. [PMID: 37418621 PMCID: PMC10615373 DOI: 10.34067/kid.0000000000000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
Key Points This study evaluates educational and employment outcomes in patients with pediatric kidney disease and assesses predictors of educational attainment and employment in young adulthood. Despite high rates of high school graduation, nearly 20% of patients with CKD are unemployed or receiving disability at long-term follow-up. Background Pediatric patients with CKD are at risk for neurocognitive deficits and academic underachievement. This population may be at risk for lower educational attainment and higher rates of unemployment; however, published data have focused on patients with advanced CKD and exist in isolation from assessment of neurocognition and kidney function. Methods Data from the CKD in Children (CKiD) cohort study were used to characterize educational attainment and employment status in young adults with CKD. We used ratings of executive function as a predictor of future educational attainment and employment status. Linear regression models predicted the highest grade level completed. Logistic regression models predicted unemployment. Results A total of 296 CKiD participants aged 18 years or older had available educational data. In total, 220 of 296 had employment data. By age 22 years, 97% had completed high school and 48% completed 2+ years of college. Among those reporting employment status, 58% were part-time or full-time employed, 22% were nonworking students, and 20% were unemployed and/or receiving disability. In adjusted models, lower kidney function (P = 0.02), worse executive function (P = 0.02), and poor performance on achievement testing (P = 0.004) predicted lower grade level completed relative to expectation for age. Conclusions CKiD study patients appear to have a better high school graduation rates (97%) than the adjusted national high school graduation rate (86%). Conversely, roughly 20% of participants were unemployed or receiving disability at study follow-up. Tailored interventions may benefit patients with CKD with lower kidney function and/or executive function deficits to optimize educational/employment outcomes in adulthood.
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Affiliation(s)
- Lyndsay A. Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ryan C. Ward
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Matthew B. Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne Dawson
- Section of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy J. Kogon
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Stephen J. Molitor
- Medical College of Wisconsin, Department of Pediatrics, Division of Pediatric Psychology, Milwaukee, Wisconsin
| | - Rebecca J. Johnson
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Camille Wilson
- Section of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Bradley A. Warady
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Susan L. Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen R. Hooper
- Department of Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Chen CC, Chu CH, Lin YC, Huang CC. Neurodevelopment After Neonatal Acute Kidney Injury in Very Preterm-Birth Children. Kidney Int Rep 2023; 8:1784-1791. [PMID: 37705902 PMCID: PMC10496073 DOI: 10.1016/j.ekir.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction This study aimed to assess head circumference (HC) growth and neurodevelopmental outcomes in very preterm-birth children after neonatal acute kidney injury (AKI). Methods This longitudinal follow-up cohort included 732 very preterm neonates of gestational age <31 weeks admitted to a tertiary center between 2008 and 2020. AKI was categorized as nonoliguric and oliguric AKI based on the urine output criteria during admission. We compared the differences in death, z scores of HC (zHC) at term-equivalent age (TEA) and at corrected ages of 6, 12, and 24 months, and the neurodevelopmental outcomes at corrected age of 24 months after neonatal nonoliguric and oliguric AKI. Results Among the 154 neonates who developed AKI, 72 had oliguric AKI and 82 had nonoliguric AKI. At TEA, oliguric AKI, but not nonoliguric AKI, was independently associated with lower zHC than non-AKI (mean differences, -0.49; 95% confidence interval [CI], -0.92 to -0.06). Although the 3 groups were comparable in zHC at corrected ages of 6, 12, and 24 months, the oliguric AKI group, but not the nonoliguric AKI group, had a higher rate of microcephaly by corrected age of 24 months. In addition, the oliguric AKI group, but not the nonoliguric AKI group, was more likely to die (61% vs. 9%) and have neurodevelopmental impairment (41% vs. 14%) compare with the non-AKI group. After adjustment, oliguric (adjusted odds ratio [aOR], 8.97; 95% CI, 2.19-36.76), but not nonoliguric, AKI was associated with neurodevelopmental impairment. Conclusion Neonatal oliguric AKI is associated with neurodevelopmental impairment in very preterm-birth children. Long-term head-size and neurodevelopmental follow-up after neonatal AKI is warranted.
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Affiliation(s)
- Chih-Chia Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, Tunghai University, Taichung, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Rybi Szumińska A, Wasilewska A, Kamianowska M. Protein Biomarkers in Chronic Kidney Disease in Children-What Do We Know So Far? J Clin Med 2023; 12:3934. [PMID: 37373629 DOI: 10.3390/jcm12123934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic kidney disease (CKD) in children is a major concern of medical care and public health as it is related to high morbidity and mortality due to progression to end-stage kidney disease (ESKD). It is essential to identify patients with a risk of developing CKD to implement therapeutic interventions. Unfortunately, conventional markers of CKD, such as serum creatinine, glomerular filtration rate (GFR) and proteinuria, have many limitations in serving as an early and specific diagnostic tool for this condition. Despite the above, they are still the most frequently utilized as we do not have better. Studies from the last decade identified multiple CKD blood and urine protein biomarkers but mostly assessed the adult population. This article outlines some recent achievements and new perspectives in finding a set of protein biomarkers that might improve our ability to prognose CKD progression in children, monitor the response to treatment, or even become a potential therapeutic target.
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Affiliation(s)
- Agnieszka Rybi Szumińska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
| | - Anna Wasilewska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
| | - Monika Kamianowska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
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Lullmann O, Conrad AL, Steinbach EJ, Wilgenbusch T, Harshman LA, van der Plas E. Neurocognitive deficits may not resolve following pediatric kidney transplantation. Pediatr Transplant 2023; 27:e14505. [PMID: 36932049 PMCID: PMC11001201 DOI: 10.1111/petr.14505] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Pediatric chronic kidney disease (CKD) patients are at risk for cognitive deficits with worsening disease progression. Limited, existing cross-sectional studies suggest that cognitive deficits may improve following kidney transplantation. We sought to assess cognitive performance in relationship to kidney transplantation and kidney-specific medical variables in a sample of pediatric kidney transplant patients who provided cross-sectional and longitudinal observations. METHODS A retrospective chart review was conducted in patients who completed pre- and/or post-transplant neurocognitive testing at the University of Iowa from 2015-2021. Cognitive outcomes were investigated with developmentally appropriate, standardized measures. Mixed linear models estimated the impact of transplant status on cognitive function (z-scores). Subsequent post-hoc t-tests on change scores were limited to patients who had provided pre- and post-transplant assessments. RESULTS Thirty eight patients underwent cognitive assessments: 10 had both pre- and post-transplant cognitive assessments, 11 had pre-transplant assessments only, and 17 had post-transplant data only. Post-transplant status was associated with significantly lower full-scale IQ and slower processing speed compared to pre-transplant status (estimate = -0.32, 95% confidence interval [CI] = -0.52: -0.12; estimate = -0.86, CI = -1.17: -0.55, respectively). Post-hoc analyses confirmed results from the mixed models (FSIQ change score = -0.34, 95% CI = -0.56: -0.12; processing speed change score = -0.98, CI = -1.28: -0.68). Finally, being ≥80 months old at transplant was associated with substantially lower FSIQ compared to being <80 months (estimate = -1.25, 95% CI = -1.94: -0.56). CONCLUSIONS Our results highlight the importance of monitoring cognitive function following pediatric kidney transplant and identify older transplant age as a risk factor for cognitive deficits.
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Affiliation(s)
- Olivia Lullmann
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Amy L Conrad
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Emily J Steinbach
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tammy Wilgenbusch
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Lyndsay A Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
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14
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Singh NS, Johnson RJ, Matheson MB, Carlson J, Hooper SR, Warady BA. A longitudinal analysis of the effect of anemia on executive functions in children with mild to moderate chronic kidney disease. Pediatr Nephrol 2023; 38:829-837. [PMID: 35861871 PMCID: PMC10659592 DOI: 10.1007/s00467-022-05682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) are at risk for cognitive dysfunction. The aim of this study was to investigate associations between executive functions (EF), anemia, and iron deficiency. METHODS A total of 688 children > 6 years of age enrolled in the Chronic Kidney Disease in Children (CKiD) study who underwent evaluation for EF were included. Hemoglobin (Hgb) was characterized as low (1st-5th percentile) or very low (< 1st percentile) compared to normative values for age, sex, and race irrespective of erythropoiesis-stimulating agent (ESA) usage. Longitudinal analysis was conducted using consecutive visit pairs, with anemia status defined as new onset, resolved, or persistent. Linear mixed models with random intercept were used and adjusted for key covariates. RESULTS Anemia was present in 41% of children, and median Hgb was 11.8 gm/dl. New onset anemia was associated with lower digit span total score (- 0.75, 95% CI - 1.36, - 0.15, p = 0.01). Persistent anemia was associated with lower scores on color-word inhibition/switching (β = - 0.98; 95% CI - 1.78, - 0.18, p = 0.02). Errors of omission were significantly higher (worse) in those with persistent anemia (β = 2.67, 95% CI 0.18, 5.17, p = 0.04). Very low Hgb levels were significantly associated with lower color-word inhibition/switching scores (β = - 1.33, 95% CI - 2.16, - 0.51; p = 0.002). Anemia and low GFR were associated with lower category fluency scores compared to non-anemic subjects with higher GFR (β = - 1.09, 95% CI - 2.09, - 0.10, p = 0.03). CONCLUSIONS The presence of anemia, in addition to its severity and duration in children with CKD, is associated with poorer scores on select measures of EF. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Nisha S Singh
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA.
| | | | - Matthew B Matheson
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Joann Carlson
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Stephen R Hooper
- Department of Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
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15
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Dawson AE, Wilson CS, Smoyer WE, Pottanat N, Wilson AC, Mahan JD, LaMotte JE. Psychosocial supports within pediatric nephrology practices: A pediatric nephrology research consortium survey. PLoS One 2023; 18:e0285126. [PMID: 37159451 PMCID: PMC10168552 DOI: 10.1371/journal.pone.0285126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/15/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND The landscape of available psychosocial services within pediatric nephrology care is poorly characterized. However, the effects of kidney disease on emotional health and health-related quality of life are well documented, as is the impact of social determinants of health on kidney disease outcomes. The objectives of this study were to assess pediatric nephrologists' perceptions of available psychosocial services and to elucidate inequities in access to psychosocial care. METHODS A web-based survey was distributed to members of the Pediatric Nephrology Research Consortium (PNRC). Quantitative analyses were performed. RESULTS We received responses from 49 of the 90 PNRC centers. With regards to dedicated services, social work was most commonly available (45.5-100%), followed by pediatric psychology (0-57.1%) and neuropsychology (0-14.3%), with no centers having embedded psychiatry. Availability of psychosocial providers was positively associated with nephrology division size, such that as center size increased, access to various psychosocial providers increased. Notably, the majority of respondents indicated that perceived need for psychosocial support exceeds that which is currently available, even at centers with higher levels of current support. CONCLUSIONS Within the US, there is wide variability in the availability of psychosocial services within pediatric nephrology centers despite a well-documented necessity for the provision of holistic care. Much work remains to better understand the variation in funding for psychosocial services and in utilization of psychosocial professionals in the pediatric nephrology clinic, and to inform key best practices for addressing the psychosocial needs of patients with kidney disease.
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Affiliation(s)
- Anne E Dawson
- Department of Psychology and Pediatric Neuropsychology, Nationwide Children's Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States of America
| | - Camille S Wilson
- Department of Psychology and Pediatric Neuropsychology, Nationwide Children's Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States of America
| | - William E Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States of America
- Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Neha Pottanat
- Division of Nephrology, Riley Hospital for Children, Indianapolis, IN, United States of America
- Division of Hematology/Oncology, Riley Hospital for Children, Indianapolis, IN, United States of America
| | - Amy C Wilson
- Division of Nephrology, Riley Hospital for Children, Indianapolis, IN, United States of America
- Division of Hematology/Oncology, Riley Hospital for Children, Indianapolis, IN, United States of America
| | - John D Mahan
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States of America
| | - Julia E LaMotte
- Division of Hematology/Oncology, Riley Hospital for Children, Indianapolis, IN, United States of America
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America
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16
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Associations between neurofilament light-chain protein, brain structure, and chronic kidney disease. Pediatr Res 2022; 91:1735-1740. [PMID: 34274959 PMCID: PMC8761779 DOI: 10.1038/s41390-021-01649-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neurofilament light-chain (NfL) protein is a blood-based marker of neuroaxonal injury. We sought to (1) compare plasma NfL levels in children with chronic kidney disease (CKD) and healthy peers, (2) characterize the relationship between NfL level and kidney function, and (3) evaluate NfL as a predictor of abnormal brain structure in CKD. METHODS Sixteen children with CKD due to congenital kidney anomalies and 23 typically developing peers were included. Plasma NfL was quantified using single-molecule array immunoassay. Participants underwent structural magnetic resonance imaging. Multiple linear regression models were used to evaluate the association between plasma NfL levels, kidney function, and brain structure. RESULTS An age × group interaction was identified whereby NfL levels increased with age in the CKD group only (estimate = 0.65; confidence interval (CI) = 0.08-1.22; p = 0.026). Decreased kidney function was associated with higher NfL levels (estimate = -0.10; CI = -0.16 to -0.04; p = 0.003). Lower cerebellar gray matter volume predicted increased plasma NfL levels (estimate = -0.00024; CI = -0.00039 to 0.00009; p = 0.004) within the CKD group. CONCLUSIONS Children with CKD show accelerated age-related increases in NfL levels. NfL level is associated with lower kidney function and abnormal brain structure in CKD. IMPACT NfL is a component of the neuronal cytoskeleton providing structural axonal support. Elevated NfL has been described in relation to gray and white matter brain volume loss. We have previously described the abnormal cerebellar gray matter in CKD. We explored the relationship between NfL, CKD, and brain volume. There is an accelerated, age-related increase in NfL level in CKD. Within the CKD sample, NfL level is associated with abnormal kidney function and brain structure. Decreased kidney function may be linked to abnormal neuronal integrity in pediatric CKD.
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Riedl Khursigara M, Matsuda-Abedini M, Radhakrishnan S, Hladunewich MA, Lemaire M, Teoh CW, Noone D, Licht C. A Guide for Adult Nephrologists and Hematologists to Managing Atypical Hemolytic Uremic Syndrome and C3 Glomerulopathy in Teens Transitioning to Young Adults. Adv Chronic Kidney Dis 2022; 29:231-242. [PMID: 36084970 DOI: 10.1053/j.ackd.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
Abstract
Atypical hemolytic uremic syndrome and C3 glomerulopathy/immune complex membranoproliferative glomerulonephritis are ultra-rare chronic, complement-mediated diseases with childhood manifestation in a majority of cases. Transition of clinical care of patients from pediatric to adult nephrologists-typically with controlled disease in native or transplant kidneys in case of atypical hemolytic uremic syndrome and often with chronic progressive disease despite treatment efforts in case of C3 glomerulopathy/immune complex membranoproliferative glomerulonephritis-identifies a challenging juncture in the journey of these patients. Raising awareness for the vulnerability of this patient cohort; providing education on disease pathophysiology and management including the use of new, high-precision complement antagonists; and establishing an ongoing dialog of patients, families, and all members of the health care team involved on either side of the age divide will be inevitable to ensure optimal patient outcomes and a safe transition of these patients to adulthood.
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Affiliation(s)
| | - Mina Matsuda-Abedini
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Seetha Radhakrishnan
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle A Hladunewich
- Division of Nephrology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mathieu Lemaire
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Damien Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
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18
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Pruette CS, Ranch D, Shih WV, Ferris MDG. Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems. Adv Chronic Kidney Dis 2022; 29:318-326. [PMID: 36084978 DOI: 10.1053/j.ackd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.
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Affiliation(s)
| | - Daniel Ranch
- Department of Pediatrics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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19
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Pande CK, Noll L, Afonso N, Serrano F, Monteiro S, Guffey D, Puri K, Achuff BJ, Akcan-Arikan A, Shekerdemian L. Neurodevelopmental Outcomes in Infants with Cardiac Surgery Associated Acute Kidney Injury. Ann Thorac Surg 2022; 114:2347-2354. [PMID: 35346625 DOI: 10.1016/j.athoracsur.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Infants who undergo surgery for congenital heart disease (CHD) are at risk of neurodevelopmental delay. Cardiac surgery associated acute kidney injury (CS-AKI) is common but its association with neurodevelopment has not been explored. METHODS Single center retrospective observational study of infants who underwent cardiac surgery in the first year of life who had neurodevelopmental testing using the Bayley Scale for Infant Development version 3. Single and recurrent episodes of Stage 2 and 3 CS-AKI were determined. RESULTS 203 children with median age at first surgery of 12 days. 31% had ≥ 1 episode of severe CS-AKI; of those, 16% had recurrent CS-AKI. Median age at neurodevelopmental assessment was 20 months. The incidence of delay was similar in patients with and without CS-AKI but all children with recurrent CS-AKI had a delay in ≥1 domain and had significantly lower scores in all 3 domains (cognitive, language, motor). CONCLUSIONS This is the first study to assess the association of CS-AKI with neurodevelopmental delay after surgery for CHD in infancy. Infants who develop recurrent CS-AKI in the first year of life were more likely to be delayed and have lower neurodevelopmental scores.
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Affiliation(s)
- Chetna K Pande
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine
| | - Lisa Noll
- Division of Psychology, Department of Pediatrics, Baylor College of Medicine
| | - Natasha Afonso
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine
| | - Faridis Serrano
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine
| | - Sonia Monteiro
- Division of Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine
| | - Kriti Puri
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine
| | - Barbara-Jo Achuff
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine
| | - Ayse Akcan-Arikan
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine; Division of Nephrology, Department of Pediatrics, Baylor College of Medicine
| | - Lara Shekerdemian
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine.
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20
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Fernandez HE, Foster BJ. Long-Term Care of the Pediatric Kidney Transplant Recipient. Clin J Am Soc Nephrol 2022; 17:296-304. [PMID: 33980614 PMCID: PMC8823932 DOI: 10.2215/cjn.16891020] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize the transition to adult-oriented transplant care and long-term outcomes.
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Affiliation(s)
- Hilda E. Fernandez
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Bethany J. Foster
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada,Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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21
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Kim S, Van Zwieten A, Lorenzo J, Khalid R, Lah S, Chen K, Didsbury M, Francis A, Mctaggart S, Walker A, Mackie FE, Prestidge C, Teixeira-Pinto A, Tong A, Blazek K, Barton B, Craig JC, Wong G. Cognitive and academic outcomes in children with chronic kidney disease. Pediatr Nephrol 2022; 37:2715-2724. [PMID: 35243536 PMCID: PMC9489550 DOI: 10.1007/s00467-022-05499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few data exist on the cognitive and academic functioning of children with chronic kidney disease (CKD) over the trajectory of their illness. We aimed to determine the association between CKD stages and cognitive and academic performance in children over time. METHODS We included 53 participants (aged 6-18 years) with CKD stages 1-5 (n = 37), on dialysis (n = 3), or with functioning kidney transplant (n = 22) from three units in Australia from 2015 to 2019. Participants undertook a series of psychometric tests and were invited for repeated assessments annually. We used linear regression and linear mixed models to investigate the effect of CKD stage, adjusted for socioeconomic status. RESULTS At baseline, full-scale intelligence quotient (FSIQ) (95%CI) of children on kidney replacement therapy (KRT) was in the low average range (87: 78, 96) and average (101: 95, 108) for children with CKD 1-5. Mean (95%CI) FSIQ, word reading, numerical operations, and spelling scores for children on KRT were 14.3 (- 25.3, - 3.3), 11 (- 18.5, - 3.6), 8.5 (- 17.6, 0.76), and 10 (- 18.6, - 1.3) points lower than children with CKD Stages 1-5. Spelling and numerical operations scores declined by 0.7 (- 1.4, - 0.1) and 1.0 (- 2.0, 0.2) units per year increase in age, regardless of CKD stage. CONCLUSIONS Children treated with KRT have low average cognitive abilities and lower academic performance for numeracy and literacy compared to both children with CKD 1-5 and to the general population. However, the rate of decline in academic performance over time is similar for children across the full spectrum of CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia. .,Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Anita Van Zwieten
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jennifer Lorenzo
- grid.413973.b0000 0000 9690 854XKids Neuroscience Centre, The Children’s Hospital at Westmead, Sydney, Australia
| | - Rabia Khalid
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Suncica Lah
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, Australia
| | - Kerry Chen
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Madeleine Didsbury
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anna Francis
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia ,grid.240562.7Child & Adolescent Renal Service, Queensland Children’s Hospital, Brisbane, Australia
| | - Steven Mctaggart
- grid.240562.7Child & Adolescent Renal Service, Queensland Children’s Hospital, Brisbane, Australia
| | - Amanda Walker
- grid.416107.50000 0004 0614 0346Department of Renal Medicine, The Royal Children’s Hospital, Melbourne, Australia
| | - Fiona E. Mackie
- grid.414009.80000 0001 1282 788XDepartment of Nephrology, Sydney Children’s Hospital at Randwick, Sydney, Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Child Health, University of New South Wales, Sydney, Australia
| | - Chanel Prestidge
- grid.414054.00000 0000 9567 6206Department of Nephrology, Starship Children’s Hospital, Auckland, New Zealand
| | - Armando Teixeira-Pinto
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katrina Blazek
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Belinda Barton
- grid.413973.b0000 0000 9690 854XChildren’s Hospital Education Research Institute, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jonathan C. Craig
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Germaine Wong
- grid.413973.b0000 0000 9690 854XCentre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Sydney, Australia ,grid.413252.30000 0001 0180 6477Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
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22
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Pande CK, Smith MB, Soranno DE, Gist KM, Fuhrman DY, Dolan K, Conroy AL, Akcan-Arikan A. The Neglected Price of Pediatric Acute Kidney Injury: Non-renal Implications. Front Pediatr 2022; 10:893993. [PMID: 35844733 PMCID: PMC9279899 DOI: 10.3389/fped.2022.893993] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/23/2022] [Indexed: 01/03/2023] Open
Abstract
Preclinical models and emerging translational data suggest that acute kidney injury (AKI) has far reaching effects on all other major organ systems in the body. Common in critically ill children and adults, AKI is independently associated with worse short and long term morbidity, as well as mortality, in these vulnerable populations. Evidence exists in adult populations regarding the impact AKI has on life course. Recently, non-renal organ effects of AKI have been highlighted in pediatric AKI survivors. Given the unique pediatric considerations related to somatic growth and neurodevelopmental consequences, pediatric AKI has the potential to fundamentally alter life course outcomes. In this article, we highlight the challenging and complex interplay between AKI and the brain, heart, lungs, immune system, growth, functional status, and longitudinal outcomes. Specifically, we discuss the biologic basis for how AKI may contribute to neurologic injury and neurodevelopment, cardiac dysfunction, acute lung injury, immunoparalysis and increased risk of infections, diminished somatic growth, worsened functional status and health related quality of life, and finally the impact on young adult health and life course outcomes.
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Affiliation(s)
- Chetna K Pande
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Mallory B Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, United States.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States
| | - Danielle E Soranno
- Section of Nephrology, Departments of Pediatrics, Bioengineering and Medicine, University of Colorado, Aurora, CO, United States
| | - Katja M Gist
- Division of Cardiology, Department of Pediatrics, Cioncinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Dana Y Fuhrman
- Division of Critical Care Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kristin Dolan
- Division of Critical Care Medicine, Department of Pediatrics, University of Missouri Kansas City, Children's Mercy Hospital, Kansas City, MO, United States
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ayse Akcan-Arikan
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States.,Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
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23
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Khalid R, Van Zwieten A, Kim S, Didsbury M, Francis A, Mctaggart S, Walker A, Mackie FE, Prestidge C, Teixeira-Pinto A, Barton B, Lorenzo J, Lah S, Howard K, Nassar N, Au E, Tong A, Blazek K, Craig JC, Wong G. Association between socioeconomic status and academic performance in children and adolescents with chronic kidney disease. Pediatr Nephrol 2022; 37:3195-3204. [PMID: 35355084 PMCID: PMC9587100 DOI: 10.1007/s00467-022-05515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lower socioeconomic status (SES) is associated with lower academic achievement; however, this relationship is understudied in children with chronic kidney disease (CKD). This study examined the relationship between SES and academic performance in children and adolescents with CKD. METHODS A total of 377 participants aged 6-18 years with CKD stages 1-5 (n = 199), on dialysis (n = 43) or with a kidney transplant (n = 135) were recruited. Five SES measures and a composite SES index were examined for associations with parent-rated average or above average academic performance in numeracy and literacy using multivariable logistic regression. RESULTS Participants' median age was 12.6 years (IQR 8.9-15.5). Adjusted odds ratios (aOR) (95%CI) for better performance in numeracy and literacy, respectively, were 0.71 (0.44-1.15) and 0.75 (0.45-1.23) for children whose caregivers had lower educational attainment; 0.46 (0.26-0.80) and 0.53 (0.30-0.93) for lower household income; 0.52 (0.32-0.85) and 0.44 (0.26-0.73) for caregivers who were unemployed; 0.68 (0.41-1.12) and 0.59 (0.35-1.00) for caregivers with poor self-rated financial status; and 0.93 (0.53-1.64) and 1.00 (0.56-1.79) for caregivers who did not own their own home. Compared with the highest SES index quartile, the aORs for better performance by SES quartile in descending order were 1.24 (0.60-2.54), 0.76 (0.37-1.58), and 0.39 (0.18-0.86) for numeracy and 0.88 (0.41-1.85), 0.77 (0.35-1.66), and 0.32 (0.14-0.72) for literacy. No interactions were identified between SES and CKD stage, child age, or gender. CONCLUSIONS Across all CKD stages, children from lower SES families are less likely to perform well in literacy and numeracy than those from higher SES households. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rabia Khalid
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Anita Van Zwieten
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Madeleine Didsbury
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anna Francis
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Child & Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Steven Mctaggart
- Child & Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Amanda Walker
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Australia
| | - Fiona E Mackie
- Department of Nephrology, Sydney Children's Hospital at Randwick, Sydney, Australia
| | - Chanel Prestidge
- Department of Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Sydney, Australia
| | - Jennifer Lorenzo
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Eric Au
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katrina Blazek
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
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24
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Kumar J, Perwad F. Adverse Consequences of Chronic Kidney Disease on Bone Health in Children. Semin Nephrol 2021; 41:439-445. [PMID: 34916005 DOI: 10.1016/j.semnephrol.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic kidney disease (CKD) mineral bone disorder has long-term effects on skeletal integrity and growth. Abnormalities in serum markers of mineral metabolism are evident early in pediatric CKD. Bone deformities, poor linear growth, and high rates of fractures are common in children with CKD. Newer imaging modalities such as high-resolution peripheral quantitative computed tomography shows promise in assessing bone mineral density more comprehensively and predicting incident fractures. A lack of large-scale studies that provide a comprehensive assessment of bone histology and correlations with serum biomarkers has contributed to the absence of evidence-based guidelines and suboptimal management of CKD mineral bone disorder in children with CKD.
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Affiliation(s)
- Juhi Kumar
- Department of Pediatrics and Population Health Sciences, Weill Cornell Medicine, New York, NY.
| | - Farzana Perwad
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
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25
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Neurocognition in Pediatric Chronic Kidney Disease: A Review of Data From the Chronic Kidney Disease in Children (CKiD) Study. Semin Nephrol 2021; 41:446-454. [PMID: 34916006 DOI: 10.1016/j.semnephrol.2021.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pediatric chronic kidney disease (CKD) is associated with deficits in neurocognitive functioning, ranging from mild to severe, and correlated with the severity of kidney disease. Clinical variables that are associated with neurocognitive deficits include lower kidney function, hypertension, proteinuria, and metabolic acidosis. Commonly reported neurocognitive difficulties include academic underachievement and deficits in attention regulation and executive function as well as somewhat lower intellectual abilities compared with peer and normative data. Although often mild, these neurocognitive deficits may have broad implications for quality of life and likely contribute to both poorer high school graduation rates and long-term underemployment in the adult CKD population. The presence of neurocognitive deficits in predialytic CKD has been well characterized, but further longitudinal research is warranted to describe cognitive changes as children progress from early stage CKD to kidney replacement therapy. Such studies should include both cognitive and neuroimaging evaluations to better inform the impact of CKD progression on neurocognitive outcomes.
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26
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Abstract
Serum creatinine and level of proteinuria, as biomarkers of chronic kidney disease (CKD) progression, inadequately explain the variability of glomerular filtration rate decline, and are late markers of glomerular filtration rate decline. Recent studies have identified plasma and urine biomarkers at higher levels in children with CKD and also associate independently with CKD progression, even after adjustment for serum creatinine and proteinuria. These novel biomarkers represent diverse biologic pathways of tubular injury, tubular dysfunction, inflammation, and tubular health, and can be used as a liquid biopsy to better characterize CKD in children. In this review, we highlight the biomarker findings from the Chronic Kidney Disease in Children cohort, a large longitudinal study of children with CKD, and compare results with those from other pediatric CKD cohorts. The biomarkers in focus in this review include plasma kidney injury molecule-1, monocyte chemoattractant protein-1, fibroblast growth factor-23, tumor necrosis factor receptor-1, tumor necrosis factor receptor-2, soluble urokinase plasminogen activator receptor, and chitinase-3-like protein 1, as well as urine epidermal growth factor, α-1 microglobulin, kidney injury molecule-1, monocyte chemoattractant protein-1, and chitinase-3-like protein 1. Blood and urine biomarkers improve our ability to prognosticate CKD progression and may improve our understanding of CKD pathophysiology. Further research is required to establish how these biomarkers can be used in the clinical setting to improve the clinical management of CKD.
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Affiliation(s)
- Ibrahim Sandokji
- Section of Nephrology, Clinical and Translational Research Accelerator, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Pediatrics, Taibah University College of Medicine, Medina, Saudi Arabia
| | - Jason H Greenberg
- Section of Nephrology, Clinical and Translational Research Accelerator, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
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27
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Lentine KL, Pastan S, Mohan S, Reese PP, Leichtman A, Delmonico FL, Danovitch GM, Larsen CP, Harshman L, Wiseman A, Kramer HJ, Vassalotti J, Joseph J, Longino K, Cooper M, Axelrod DA. A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation. Am J Kidney Dis 2021; 78:319-332. [PMID: 34330526 DOI: 10.1053/j.ajkd.2021.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity. Strategies targeting the critical goal of decreasing organ discard that warrant research investment include educating patients and clinicians about potential benefits of accepting nonstandard organs, use of novel organ assessment technologies and real-time decision support, and approaches to preserve and resuscitate allografts before implantation. The development of personalized strategies to reduce the burden of lifelong immunosuppression and support "one transplant for life" was also identified as a vital priority. The panel noted the specific goal of improving transplant access and graft survival for children with kidney failure. This ambitious agenda will focus research investment to promote greater equity and efficiency in access to transplantation, and help sustain long-term benefits of the gift of life for more patients in need.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St Louis, MO.
| | - Stephen Pastan
- Department of Medicine, Emory Transplant Center, Atlanta, GA
| | - Sumit Mohan
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA
| | - Alan Leichtman
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | - Lyndsay Harshman
- Department of Pediatrics, University of Iowa Transplant Institute, Iowa City, IA
| | - Alexander Wiseman
- Department of Medicine, Centura Health-Porter Adventist Hospital, Aurora, CO
| | | | - Joseph Vassalotti
- National Kidney Foundation, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Matthew Cooper
- Department of Surgery, Medstar Georgetown Transplant Institute, Washington, DC
| | - David A Axelrod
- Department of Surgery, University of Iowa Transplant Institute, Iowa City, IA
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28
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Hutton JS, DeWitt T, Hoffman L, Horowitz-Kraus T, Klass P. Development of an Eco-Biodevelopmental Model of Emergent Literacy Before Kindergarten: A Review. JAMA Pediatr 2021; 175:730-741. [PMID: 33720328 DOI: 10.1001/jamapediatrics.2020.6709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Literacy has been described as an important social determinant of health. Its components emerge in infancy and are dependent on genetic, medical, and environmental factors. The American Academy of Pediatrics advocates a substantial role for pediatricians in literacy promotion, developmental surveillance, and school readiness to promote cognitive, relational, and brain development. Many children, especially those from minority and underserved households, enter kindergarten unprepared to learn to read and subsequently have difficulty in school. OBSERVATIONS Emergent literacy is a developmental process beginning in infancy. Component skills are supported by brain regions that must be adequately stimulated and integrated to form a functional reading network. Trajectories are associated with genetic, medical, and environmental factors, notably the home literacy environment, which is defined as resources, motivation, and stimulation that encourage the literacy development process. Eco-biodevelopmental models are advocated by the American Academy of Pediatrics, and these models offer insights into the neurobiological processes associated with environmental factors and the ways in which these processes may be addressed to improve outcomes. Emergent literacy is well suited for such a model, particularly because the mechanisms underlying component skills are elucidated. In addition to cognitive-behavioral benefits, the association of home literacy environment with the developing brain before kindergarten has recently been described via neuroimaging. Rather than a passive approach, which may subject the child to stress and engender negative attitudes, early literacy screening and interventions that are administered by pediatric practitioners can help identify potential reading difficulties, address risk factors during a period when neural plasticity is high, and improve outcomes. CONCLUSIONS AND RELEVANCE Neuroimaging and behavioral evidence inform an eco-biodevelopmental model of emergent literacy that is associated with genetic, medical, and home literacy environmental factors before kindergarten, a time of rapid brain development. This framework is consistent with recommendations from the American Academy of Pediatrics and provides insights to help identify risk factors and signs of potential reading difficulties, tailor guidance, and provide direction for future research.
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Affiliation(s)
- John S Hutton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Thomas DeWitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lauren Hoffman
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tzipi Horowitz-Kraus
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Educational Neuroimaging Center, Faculty of Education in Science and Technology, Technion, Haifa, Israel.,Faculty of Biomedical Engineering, Technion, Haifa, Israel
| | - Perri Klass
- Department of Pediatrics, New York University School of Medicine, New York
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29
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Kang NR, Ahn YH, Park E, Lee KH, Baek HS, Kim SH, Cho H, Cho MH, Shin JI, Lee JH, Cheong HI, Kang HG, Park YS, Ha IS, Moon DS, Han KH. Intellectual Functioning of Pediatric Patients with Chronic Kidney Disease: Results from the KNOW-Ped CKD. J Korean Med Sci 2021; 36:e138. [PMID: 34032031 PMCID: PMC8144594 DOI: 10.3346/jkms.2021.36.e138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/14/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. METHODS Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6-16 years), or Wechsler Adult Intelligence Scale (> 16 years). RESULTS The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < -1.88), failure to thrive (weight Z scores < -1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. CONCLUSION On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02165878.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eujin Park
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Sun Baek
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center Childrens' Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center Childrens' Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Duk Soo Moon
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Kyoung Hee Han
- Department of Pediatrics, College of Medicine, Jeju National University, Jeju, Korea.
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30
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Zelikovsky N, Nelson E. Illness perceptions and beliefs about medication: impact on health-related quality of life in adolescent kidney transplant recipients. Pediatr Transplant 2021; 25:e13988. [PMID: 33590948 DOI: 10.1111/petr.13988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022]
Abstract
Adolescents diagnosed with chronic kidney disease (CKD) who undergo kidney transplantation have to adjust to pervasive effects of chronic illness and life-long treatment maintenance, alongside normative developmental stressors. The way in which adolescent transplant recipients experience and think about their illness as well as their medication regimen can be a crucial factor impacting psychosocial outcomes. Participants were 26 adolescent kidney transplant recipients (μ = 16.8 years, σ = 1.69 years) who completed self-report surveys during a clinic visit. Multiple linear regressions were used to investigate whether adolescents' beliefs about medications and attitudes and perceptions of their illness are associated with their overall quality of life. Adolescents' negative illness perceptions contributed to lower transplant-specific health-related quality of life ratings (ΔR2 =.305, p < .01). Additionally, adolescent beliefs about their specific medication regimens (ie, personal medication concerns) (ΔR2 =.342, p < .01), and general beliefs about medication use (ie, harm, overuse) (ΔR2 =.241, p < .05) also contribute significantly to the variance in their overall quality of life ratings. Adolescent transplant patients in older grades and those in special education endorsed lower quality of life. Cognitive components (eg, beliefs, perceptions) of an adolescent kidney transplant recipient's experience contribute to transplant-related quality of life outcomes. This highlights a point of intervention where cognitive change interventions may be utilized and efficacious in improving health outcomes.
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Affiliation(s)
- Nataliya Zelikovsky
- Psychology Department, La Salle University, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elena Nelson
- Psychology Department, La Salle University, Philadelphia, PA, USA
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31
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Puma L, Doyle M. Long-term psychosocial outcomes of adults transplanted in childhood: A social work perspective. Pediatr Transplant 2021; 25:e13859. [PMID: 33105051 DOI: 10.1111/petr.13859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022]
Abstract
While much research exists regarding medical outcomes for pediatric end stage renal disease (ESRD) populations and for adults receiving dialysis or kidney transplant, the understanding of long-term psychosocial outcomes for individuals diagnosed with ESRD or transplanted in childhood remains limited. A literature review was undertaken by two social work researchers to identify relationship, education, employment, and quality of life (QOL) outcomes for this population utilizing PUBMED and PsycInfo databases. Inconsistencies in the MeSH terms and keywords used across the relevant articles were noted. The impact of transplantation in childhood is significant across multiple facets of social development including but not limited to peer/intimate relationships, education and employment and QOL, and overall well-being. When compared to healthy peers, those with ESRD were delayed in all areas of social development. While improvements in psychosocial outcomes have occurred alongside improved graft and patient survival, more focused longitudinal and qualitative inquiry is needed. Partnerships are needed across disciplines and across those caring for different age cohorts in pediatric, adult nephrology, and transplant practices.
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Affiliation(s)
- Lynn Puma
- School of Social Work, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Maya Doyle
- Department of Social Work, School of Health Sciences, Quinnipiac University, Hamden, CT, USA
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32
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Amatya K, Monnin K, Steinberg Christofferson E. Psychological functioning and psychosocial issues in pediatric kidney transplant recipients. Pediatr Transplant 2021; 25:e13842. [PMID: 33012109 DOI: 10.1111/petr.13842] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
Research demonstrates that psychological factors are important for positive transplant outcomes, though there is little literature that synthesizes these factors in a comprehensive model among pediatric kidney transplant patients. This review analyzes psychological and psychosocial factors related to medical outcomes and overall well-being post-transplant by utilizing the PPPHM and referencing the existing literature on risk and resilience. Pediatric kidney transplant recipients are more susceptible to mental health concerns such as depression, anxiety, and ADHD, as well as developmental and neurocognitive delays, compared to healthy peers. Complex medical care and psychosocial needs for patients have implications for family functioning, parental and sibling mental health, and youth readiness to transition to adult care. It is important to carefully monitor patient functioning with empirically validated tools and to intervene in a multidisciplinary setting as early as possible to identify patients at risk and reduce potential negative impact. Psychologists are uniquely trained to assess and address these issues and are a valuable component of multidisciplinary, culturally competent care. While research in this expansive field is improving, more data are needed to establish gold standard approaches to mental health and psychosocial care in this population.
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Affiliation(s)
- Kaushalendra Amatya
- Divisions of Nephrology and Cardiology, Children's National Hospital, Washington, DC, USA.,Pediatrics and Psychiatry & Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kara Monnin
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Elizabeth Steinberg Christofferson
- Solid Organ Transplant Surgery, Children's Hospital Colorado, Aurora, CO, USA.,Departments of Psychiatry and Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Lopez-Garcia SC, Downie ML, Kim JS, Boyer O, Walsh SB, Nijenhuis T, Papizh S, Yadav P, Reynolds BC, Decramer S, Besouw M, Perelló Carrascosa M, La Scola C, Trepiccione F, Ariceta G, Hummel A, Dossier C, Sayer JA, Konrad M, Keijzer-Veen MG, Awan A, Basu B, Chauveau D, Madariaga L, Koster-Kamphuis L, Furlano M, Zacchia M, Marzuillo P, Tse Y, Dursun I, Pinarbasi AS, Tramma D, Hoorn EJ, Gokce I, Nicholls K, Eid LA, Sartz L, Riordan M, Hooman N, Printza N, Bonny O, Arango Sancho P, Schild R, Sinha R, Guarino S, Martinez Jimenez V, Rodríguez Peña L, Belge H, Devuyst O, Wlodkowski T, Emma F, Levtchenko E, Knoers NVAM, Bichet DG, Schaefer F, Kleta R, Bockenhauer D. Treatment and long-term outcome in primary nephrogenic diabetes insipidus. Nephrol Dial Transplant 2020; 38:gfaa243. [PMID: 33367818 DOI: 10.1093/ndt/gfaa243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary nephrogenic diabetes insipidus (NDI) is a rare disorder and little is known about treatment practices and long-term outcome. METHODS Paediatric and adult nephrologists contacted through European professional organizations entered data in an online form. RESULTS Data were collected on 315 patients (22 countries, male 84%, adults 35%). Mutation testing had been performed in 270 (86%); pathogenic variants were identified in 258 (96%). The median (range) age at diagnosis was 0.6 (0.0-60) years and at last follow-up 14.0 (0.1-70) years. In adults, height was normal with a mean (standard deviation) score of -0.39 (±1.0), yet there was increased prevalence of obesity (body mass index >30 kg/m2; 41% versus 16% European average; P < 0.001). There was also increased prevalence of chronic kidney disease (CKD) Stage ≥2 in children (32%) and adults (48%). Evidence of flow uropathy was present in 38%. A higher proportion of children than adults (85% versus 54%; P < 0.001) received medications to reduce urine output. Patients ≥25 years were less likely to have a university degree than the European average (21% versus 35%; P = 0.003) but full-time employment was similar. Mental health problems, predominantly attention-deficit hyperactivity disorder (16%), were reported in 36% of patients. CONCLUSION This large NDI cohort shows an overall favourable outcome with normal adult height and only mild to moderate CKD in most. Yet, while full-time employment was similar to the European average, educational achievement was lower, and more than half had urological and/or mental health problems.
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Affiliation(s)
- Sergio C Lopez-Garcia
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Ji Soo Kim
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Hereditary Kidney Diseases (MARHEA), Laboratory of Hereditary Kidney Diseases, Imagine Institute, INSERM U1163, Paris Descartes University, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris,France
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London,UK
| | - Tom Nijenhuis
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboudumc Expertisecentrum Zeldzame Nierziekten, Radboud University Medical Center, Nijmegen, TheNetherlands
| | - Svetlana Papizh
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Pallavi Yadav
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ben C Reynolds
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Stéphane Decramer
- Department of Paediatric Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds,UK
| | - Martine Besouw
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow,UK
| | | | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Woman, Child and Urological Diseases, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna,Italy
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Naples,Italy
| | - Gema Ariceta
- Department of Paediatric Nephrology, Hospital Universitario Vall d'Hebron, Barcelona,Spain
| | - Aurélie Hummel
- Department of Nephrology and Transplantation, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris,France
| | - Claire Dossier
- Department of Paediatric Nephrology, Hôpital Robert-Debre, Paris,France
| | - John A Sayer
- Translational and Clinical Medicine Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle Upon Tyne,UK
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne,UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne,UK
| | - Martin Konrad
- Department of Paediatric Nephrology, University Children's Hospital, Münster,Germany
| | - Mandy G Keijzer-Veen
- Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, TheNetherlands
| | - Atif Awan
- Department of Paediatric Nephrology, Temple Street Children's University Hospital, Dublin,Ireland
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, N. R. S. Medical College & Hospital, Kolkata,India
| | - Dominique Chauveau
- Department of Nephrology and Transplantation, Centre de Référence des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Université Toulouse-III, Toulouse,France
| | - Leire Madariaga
- Department of Paediatric Nephrology, Cruces University Hospital, IIS Biocruces-Bizkaia, University of the Basque Country, Bizkaia,Spain
| | - Linda Koster-Kamphuis
- Department of Paediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, TheNetherlands
| | - Mónica Furlano
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Department of Medicine-Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona,Spain
| | - Miriam Zacchia
- Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Naples,Italy
| | - Pierluigi Marzuillo
- Department of Women, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne,UK
| | - Ismail Dursun
- Department of Paediatrics, Division of Nephrology, Erciyes University Faculty of Medicine, Kayseri,Turkey
| | - Ayse Seda Pinarbasi
- Department of Paediatrics, Division of Nephrology, Erciyes University Faculty of Medicine, Kayseri,Turkey
| | - Despoina Tramma
- 4th Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki,Greece
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, TheNetherlands
| | - Ibrahim Gokce
- Department of Paediatric Nephrology, Marmara University, Faculty of Medicine, İstanbul,Turkey
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville,Australia
- Department of Nephrology, University of Melbourne, Parkville,Australia
| | - Loai A Eid
- Department of Paediatric Nephrology, Dubai Hospital-Dubai Health Authority, Dubai, United Arab Emirates
| | - Lisa Sartz
- Department of Clinical Sciences, Paediatric nephrology, Skåne University hospital, Lund University, Lund,Sweden
| | - Michael Riordan
- Department of Paediatric Nephrology, Temple Street Children's University Hospital, Dublin,Ireland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center (ACRDC), Aliasghar Children Hospital, Iran University of Medical Sciences, Tehran,Iran
| | - Nikoleta Printza
- 1st Paediatric Department, Aristotle University, Thessaloniki,Greece
| | - Olivier Bonny
- Service of Nephrology, Rue du Bugnon 17, Lausanne University Hospital, Lausanne,Switzerland
| | - Pedro Arango Sancho
- Department of Paediatric Nephrology and Transplantation, Hospital Sant Joan De Déu, Esplugues De Llobregat, Barcelona,Spain
| | - Raphael Schild
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg,Germany
| | - Rajiv Sinha
- Division of Paediatric Nephrology, Institute of Child Health, Kolkata,India
| | - Stefano Guarino
- Department of Women, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Victor Martinez Jimenez
- Department of Nephrology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia,Spain
| | - Lidia Rodríguez Peña
- Section of Medical Genetics, Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia,Spain
| | - Hendrica Belge
- Center of Human Genetics, Institut de Pathologie et Genetique, Gosselies,Belgium
| | - Olivier Devuyst
- Institute of Physiology, Zurich Center for Integrative Human Physiology (ZHIP), Mechanism of Inherited Kidney Disorders Group, University of Zurich, Zurich,Switzerland
| | - Tanja Wlodkowski
- Department of Paediatric Nephrology, University Children's Hospital, Heidelberg,Germany
| | - Francesco Emma
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome,Italy
| | - Elena Levtchenko
- Department of development and regeneration, Laboratory of Paediatric Nephrology, University Hospital, Leuven,Belgium
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, TheNetherlands
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, TheNetherlands
| | - Daniel G Bichet
- Nephrology Service, Department of Medicine, Pharmacology and Physiology, University of Montreal, Montreal, Quebec,Canada
| | - Franz Schaefer
- Department of Paediatric Nephrology, University Children's Hospital, Heidelberg,Germany
| | - Robert Kleta
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
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34
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The brain in pediatric chronic kidney disease-the intersection of cognition, neuroimaging, and clinical biomarkers. Pediatr Nephrol 2020; 35:2221-2229. [PMID: 31897717 PMCID: PMC8493603 DOI: 10.1007/s00467-019-04417-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
Brain growth and development occur at peak rates in early childhood through adolescence, and for some children, this must happen in conjunction with chronic kidney disease (CKD), associated medical conditions, and their treatment(s). This review provides an overview of key findings to date on the topic of the brain in pediatric CKD. Here, we specifically address the topics of neuroimaging and cognition in pediatric CKD with consideration to biomarkers of disease progression that may impact cognition. Current cognitive data suggest that most children with mild to moderate CKD do not exhibit significant cognitive impairments, but, rather, the presence of somewhat lower intellectual abilities and subtle deficits in selected executive functions. Although promising, modern neuroimaging data remain inconclusive in linking cognitive findings to neuroimaging correlates in the pediatric CKD population. Certainly, it is important to note that even subtle cognitive concerns can present barriers to learning, social functioning, and overall quality of life if not appropriately recognized or addressed. Further longitudinal research utilizing concurrent and targeted cognitive and neuroimaging evaluations is warranted to better understand the impact of CKD progression on brain development and associated neurocognitive outcomes.
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35
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A longitudinal examination of parent-reported emotional-behavioral functioning of children with mild to moderate chronic kidney disease. Pediatr Nephrol 2020; 35:1287-1295. [PMID: 32157444 PMCID: PMC8210580 DOI: 10.1007/s00467-020-04511-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with mild to moderate chronic kidney disease (CKD) are at increased risk for deficits in neurocognition. Less is known about how CKD affects emotional-behavioral functioning in this population. METHODS Parent ratings of emotional-behavioral functioning at baseline and over time were examined for 845 children with mild to moderate CKD using the Behavior Assessment System for Children, Second Edition Parent Rating Scales (BASC-2 PRS). Associations with demographic and disease-related predictors were also examined. RESULTS Children with mild to moderate CKD had parent-reported emotional-behavioral functioning largely within normal limits, at baseline and over time. The proportion with T-scores at least 1 SD above the mean was 24% for Internalizing Problems and 28% for Attention Problems. A greater proportion of participants scored lower than expected (worse) on scales measuring adaptive skills (25%). Persistent hypertension predicted attention problems (β = 1.59, 95% CI = 0.24 to 2.94, p < 0.02) and suggested worse behavioral symptoms (β = 1.36, 95% CI = - 0.01 to 2.73, p = 0.05). Participants with proteinuria at baseline, but not at follow-up, had fewer attention problems than participants whose proteinuria had not resolved (β = - 3.48, CI = - 6.79 to - 0.17, p < 0.04). Glomerular diagnosis was related to fewer (β = - 2.68, 95% CI = - 4.93 to - 0.42, p < 0.02) internalizing problems. CONCLUSIONS Although children with CKD generally have average emotional-behavioral parent ratings, a notable percentage of the population may be at risk for problems with attention and adaptive behavior. Providers working with this population should facilitate psychosocial referrals when indicated.
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36
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Yokoyama JS, Matsuda-Abedini M, Denburg MR, Kumar J, Warady BA, Furth SL, Hooper SR, Portale AA, Perwad F. Association Between Chronic Kidney Disease-Mineral Bone Disease (CKD-MBD) and Cognition in Children: Chronic Kidney Disease in Children (CKiD) Study. Kidney Med 2020; 2:398-406. [PMID: 32775979 PMCID: PMC7406846 DOI: 10.1016/j.xkme.2020.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rationale & Objective Chronic kidney disease (CKD) in children is associated with cognitive dysfunction that affects school performance and quality of life. The relationship between CKD-mineral and bone disorder and cognitive function in children is unknown. Study Design Observational study. Participants 702 children enrolled in the Chronic Kidney Disease in Children (CKiD) Study. Predictors Plasma fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), calcium, phosphorus, 25 hydroxyvitamin D (25[OH]D), and 1,25 dihydroxyvitamin D (1,25[OH]2D). Outcomes Neurocognitive tests of intelligence, academic achievement, and executive functions. Analytical Approach Linear regression models to analyze the cross-sectional associations between log2FGF-23, 25(OH)D, 1,25(OH)2D, PTH, calcium, and phosphorus z scores and the cognitive test scores of interest after adjustment for demographics, blood pressure, proteinuria, and kidney function. Results At baseline, median age was 12 (95% CI, 8.3, 15.2) years and estimated glomerular filtration rate was 54 (40.5, 67.8) mL/min/1.73 m2. In fully adjusted analyses, 25(OH)D, 1,25(OH)2D, PTH, calcium, and phosphorus z scores did not associate with cognitive test scores. In fully adjusted analyses, log2FGF-23 was associated with abnormal test scores for attention regulation (P < 0.05); specifically, Conners' Continuous Performance Test II Errors of Omission (β = 2.3 [1.0, 3.6]), Variability (β=1.4 [0.4, -2.4]), and Hit Reaction Time (β = 1.3 [0.2, 2.4]). Children in the highest FGF-23 tertile group had 7% and 9% greater cognitive risk for Hit Reaction Time and Errors of Omission compared with those in the lowest tertile, respectively. In fully adjusted analyses, higher FGF-23 tertile was associated with increased cognitive risk (P < 0.05) for Errors of Omission (β = 0.4 [0.1, 0.7]) and Hit Reaction Time (β = 0.4 [0.1, 0.7]). Limitations The study does not assess the cumulative effects of FGF-23 excess on cognitive function over time. Within-population stratified analyses were not performed due to limited sample size. Conclusions In children with CKD, higher plasma FGF-23 level is associated with lower performance in targeted tests of executive function, specifically attention regulation, independent of glomerular filtration rate.
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Affiliation(s)
- Jennifer S Yokoyama
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Mina Matsuda-Abedini
- Division of Nephrology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle R Denburg
- Children's Hospital of Philadelphia, Division of Nephrology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Juhi Kumar
- Division of Nephrology, Weill Cornell Medical College, New York, NY
| | - Bradley A Warady
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - Susan L Furth
- Children's Hospital of Philadelphia, Division of Nephrology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anthony A Portale
- Division of Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Farzana Perwad
- Division of Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
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37
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Kogon AJ, Harshman LA. Chronic Kidney Disease: Treatment of Comorbidities I: (Nutrition, Growth, Neurocognitive Function, and Mineral Bone Disease). ACTA ACUST UNITED AC 2019; 5:78-92. [PMID: 31840017 DOI: 10.1007/s40746-019-00152-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose of review This review discusses the complications of nutrition, growth, neurocognitive function and mineral and bone disorder in pediatric chronic kidney disease. We discuss the most recent evidence-based methods for evaluation and prevention of these complications in addition to treatment strategies to address the complications and mitigate adverse effects. Recent findings Frequent nutritional assessment is important, particularly for infants and young children. Due to anorexia, oral aversion and dietary restrictions, weight gain may be difficult to achieve. Adequate nutrition is important for growth. Children with CKD tend to be short, which can impact quality of life and social achievements. Once nutrition is optimized, growth hormone is an effective, but underutilized strategy to improving terminal height. Mineral and bone disorder is a difficult but common complication of CKD which may present with and be driven by abnormalities in calcium, phosphorus and parathyroid hormone levels. Treatment strategies include dietary phosphorus restriction, phosphorus binders, and inactive vitamin D and active vitamin D sterols. Effective treatment may reduce the risk for bone deformities, growth abnormalities, fractures, cardiovascular disease and mortality. Children with CKD also suffer from cognitive difficulties. Control of anemia, aggressive childhood nutrition, and decreased exposure to heavy metals (via dialysate and dietary binding agents) has provided substantial improvement to the more profound neurocognitive sequelae observed prior to the 1990s. Current prevention of cognitive sequelae may best be directed at improved blood pressure control and augmented school support. Summary Pediatric CKD has systemic ramifications and can impact all aspects of normal development, including nutrition, growth, bone and mineral metabolism and neurocognitive function. Regular evaluation for disease complications and prompt treatment can reduce the untoward effects of CKD thereby improving the quality and duration of life.
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Affiliation(s)
- Amy J Kogon
- Division of Nephrology, Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - Lyndsay A Harshman
- Division of Pediatric Nephrology, University of Iowa Stead Family Department of Pediatrics
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