MedicalResearch.com Interview with:
Dr. Kerry Chen
Centre for Kidney Research, The Kids Research Institute
The Children’s Hospital at Westmead, Sydney School of Public Health,
The University of Sydney
Sydney, New South Wales, Australia
MedicalResearch.com: What is the background for this study?
Response: Chronic kidney disease is a major public health issue, with end-stage disease often requiring a combination of complex medication regimens, dialysis and/or transplant surgery. In children, the major causes of CKD are genetic and congenital. The consequences of CKD in children can be long-term and debilitating especially as they transition into adulthood, affecting their physical, intellectual and emotional well-being.
To better understand these changes, the Kids Health and Wealth Study (KCAD) is the largest longitudinal cohort study of children and adolescents with CKD in Australia and New Zealand. Spread across 5 paediatric nephrology centres so far, the KCAD Study takes a life-course approach to collecting and analysing data pertaining to the interactions between reduced renal function and associated clinical, socio-economic, quality of life, psychological, cognitive and educational outcomes in children, especially as they progress in CKD stage and also as they transition into adulthood.
MedicalResearch.com: What are the main findings?
Response: As part of KCAD, this systematic review (34 studies, n=3086) shows that children and adolescents with chronic kidney disease (CKD) are at risk of poor cognitive and educational outcomes. Compared to the general population, the systematic review found that kids with CKD scored approximately 10.5 IQ points lower, with the greatest difference being 16.2 IQ points for patients on dialysis. More specifically, children with CKD had lower scores than the general population in executive function, verbal and visual memory, and tests of academic skills especially mathematics.
MedicalResearch.com: What should readers take away from your report?
Response: Our systematic review synthesised all published evidence on cognitive and educational outcomes in children with CKD – and in doing so, showed that there are global and domain-specific deficits in this cohort compared to the general population, as well as among different stages of CKD. Readers should be made aware of these differences and also that further steps in this area are necessary. Knowing that there are potential deficits in cognitive and academic outcomes (and the specific domains therein) means that kids with CKD may need to focus on these areas and that it is important for families, educators and health teams to be prepared to support these kids along any particular CKD stage through targeted programs.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The conclusions of this study are far-reaching, with implications for children with CKD, families, health teams, and education providers. Future research may focus on explaining the mechanism(s) of action for cognitive and educational deficits in children with CKD, and why they are most affected when on dialysis. With more rigorous and longitudinal studies to come in the future, it would be important to assess the changes in these outcomes over time while controlling for multiple potential confounders such as co-morbidities, age, gender, SES, and severity and chronicity of CKD. Research that is more public-health oriented may focus on preventative measures and the development of dialysis and pre-post transplant transition programs for those already affected.
Kerry Chen, Madeleine Didsbury, Anita van Zwieten, Martin Howell, Siah Kim, Allison Tong, Kirsten Howard, Natasha Nassar, Belinda Barton, Suncica Lah, Jennifer Lorenzo, Giovanni Strippoli, Suetonia Palmer, Armando Teixeira-Pinto, Fiona Mackie, Steven McTaggart, Amanda Walker, Tonya Kara, Jonathan C. Craig, and Germaine Wong
Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis
CJASN CJN.09650917; published ahead of print February 22, 2018, doi:10.2215/CJN.09650917
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