TY - JOUR T1 - Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis. AU - Chen,Kerry, AU - Didsbury,Madeleine, AU - van Zwieten,Anita, AU - Howell,Martin, AU - Kim,Siah, AU - Tong,Allison, AU - Howard,Kirsten, AU - Nassar,Natasha, AU - Barton,Belinda, AU - Lah,Suncica, AU - Lorenzo,Jennifer, AU - Strippoli,Giovanni, AU - Palmer,Suetonia, AU - Teixeira-Pinto,Armando, AU - Mackie,Fiona, AU - McTaggart,Steven, AU - Walker,Amanda, AU - Kara,Tonya, AU - Craig,Jonathan C, AU - Wong,Germaine, Y1 - 2018/02/22/ PY - 2017/09/01/received PY - 2017/12/11/accepted PY - 2018/2/24/pubmed PY - 2019/10/15/medline PY - 2018/2/24/entrez KW - Adolescent KW - Bias KW - Child KW - Cognition KW - Cohort Studies KW - Confidence Intervals KW - Cross-Sectional Studies KW - Education KW - Epidemiology and outcomes KW - Executive Function KW - Humans KW - Intelligence KW - Mathematics KW - Memory KW - Neurocognition KW - Reading KW - Renal Insufficiency, Chronic KW - Transplant Recipients KW - chronic kidney disease KW - dialysis KW - kidney transplantation KW - pediatrics KW - transplant outcomes SP - 387 EP - 397 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 13 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Poor cognition can affect educational attainment, but the extent of neurocognitive impairment in children with CKD is not well understood. This systematic review assessed global and domain-specific cognition and academic skills in children with CKD and whether these outcomes varied with CKD stage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Electronic databases were searched for observational studies of children with CKD ages 21 years old or younger that assessed neurocognitive or educational outcomes. Risk of bias was assessed using a modified Newcastle-Ottawa scale. We used random effects models and expressed the estimates as mean differences with 95% confidence intervals stratified by CKD stage. RESULTS: Thirty-four studies (25 cross-sectional, n=2095; nine cohort, n=991) were included. The overall risk of bias was high because of selection and measurement biases. The global cognition (full-scale intelligence quotient) of children with CKD was classified as low average. Compared with the general population, the mean differences (95% confidence intervals) in full-scale intelligence quotient were -10.5 (95% confidence interval, -13.2 to -7.72; all CKD stages, n=758), -9.39 (95% confidence interval, -12.6 to -6.18; mild to moderate stage CKD, n=582), -16.2 (95% confidence interval, -33.2 to 0.86; dialysis, n=23), and -11.2 (95% confidence interval, -17.8 to -4.50; transplant, n=153). Direct comparisons showed that children with mild to moderate stage CKD and kidney transplants scored 11.2 (95% confidence interval, 2.98 to 19.4) and 10.1 (95% confidence interval, -1.81 to 22.0) full-scale intelligence quotient points higher than children on dialysis. Children with CKD also had lower scores than the general population in executive function and memory (verbal and visual) domains. Compared with children without CKD, the mean differences in academic skills (n=518) ranged from -15.7 to -1.22 for mathematics, from -9.04 to -0.17 for reading, and from -14.2 to 2.53 for spelling. CONCLUSIONS: Children with CKD may have low-average cognition compared with the general population, with mild deficits observed across academic skills, executive function, and visual and verbal memory. Limited evidence suggests that children on dialysis may be at greatest risk compared with children with mild to moderate stage CKD and transplant recipients. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/29472306/Neurocognitive_and_Educational_Outcomes_in_Children_and_Adolescents_with_CKD:_A_Systematic_Review_and_Meta_Analysis_ DB - PRIME DP - Unbound Medicine ER -