Gerson Arlene C, Butler Robert, Moxey-Mims Marva, Wentz Alicia, Shinnar Shlomo, Lande Marc B, Mendley Susan R, Warady Bradley A, Furth Susan L, Hooper Stephen R
Department of Pediatrics, Johns Hopkins University Medical Institute, Baltimore, Maryland, USA.
Ment Retard Dev Disabil Res Rev. 2006;12(3):208-15. doi: 10.1002/mrdd.20116.
Given the rise in chronic kidney disease (CKD) in both children and adults, CKD has recently been targeted as a public health priority. Childhood onset kidney disease is generally a noncurable and progressive condition that leads to kidney failure by early adulthood. Fortunately, improved identification of kidney problems allows for early intervention, which is thought to slow progression toward end-stage renal disease. In addition, medical interventions for pediatric end-stage renal disease have also improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, CKD causes both direct and indirect insults to a variety of organ systems. This paper reviews recently published studies pertaining to the neurocognitive and psychosocial impact of CKD on children of various ages and at various stages of kidney failure. Specific attention is focused on summarizing peer reviewed research that describes associations between kidney functioning and cognitive functioning, language acquisition, visual spatial abilities, memory, and executive functioning. In addition, peer reviewed research describing psychosocial outcomes associated with CKD related to academic achievement, social-behavioral functioning, and quality of life are summarized. The authors also identified disease-specific factors that likely mediate neurocognitive outcomes (e.g., anemia, hypertension, cardiovascular) and endorse the importance of continued interdisciplinary research collaborations that will provide a better understanding of the mechanisms responsible for improved neurocognitive functioning after transplantation. The authors conclude this review by describing a multicenter, prospective, longitudinal, National Institutes of Health funded study that is currently examining the developmental outcomes of children with mild to moderate CKD. The authors speculate that the Chronic Kidney Disease in Children Prospective Cohort Study (CKiD) findings will provide additional evidence-based guidance for clinicians and researchers working with children and adolescents with deteriorating kidney function to improve medical and developmental outcomes.
鉴于儿童和成人慢性肾脏病（CKD）的发病率均有所上升，CKD最近已被列为公共卫生重点关注对象。儿童期发病的肾病通常是一种无法治愈的进行性疾病，到成年早期会导致肾衰竭。幸运的是，对肾脏问题的识别得到改善，从而能够进行早期干预，这被认为可以减缓向终末期肾病的进展。此外，针对小儿终末期肾病的医疗干预也有所改善，使儿童能够受益于诸如透析和肾脏移植等挽救生命的肾脏替代治疗。尽管在识别和治疗方面有所改善，但CKD会对多种器官系统造成直接和间接损害。本文回顾了最近发表的有关CKD对不同年龄和不同肾衰竭阶段儿童的神经认知和心理社会影响的研究。特别关注总结同行评审的研究，这些研究描述了肾脏功能与认知功能、语言习得、视觉空间能力、记忆和执行功能之间的关联。此外，还总结了同行评审的研究，这些研究描述了与CKD相关的心理社会结果，涉及学业成绩、社会行为功能和生活质量。作者还确定了可能介导神经认知结果的疾病特异性因素（如贫血、高血压、心血管疾病），并认可持续开展跨学科研究合作的重要性，这将有助于更好地理解移植后神经认知功能改善的机制。作者在综述结尾描述了一项由美国国立卫生研究院资助的多中心、前瞻性、纵向研究，该研究目前正在研究轻度至中度CKD儿童的发育结果。作者推测，儿童慢性肾脏病前瞻性队列研究（CKiD）的结果将为临床医生和研究人员提供更多循证指导，帮助他们为肾功能恶化的儿童和青少年改善医疗和发育结果。
