Hooper Stephen R, Laney Nina, Radcliffe Jerilynn, Moodalbail Divya, Hartung Erum A, Ruebner Rebecca L, Jawad Abbas F, Furth Susan L
*University of North Carolina School of Medicine, Chapel Hill, NC; †The Children's Hospital of Philadelphia, Philadelphia, PA; ‡The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; §Nemours/A.I. DuPont Hospital for Children, Wilmington, DE.
J Dev Behav Pediatr. 2015 Nov-Dec;36(9):734-42. doi: 10.1097/DBP.0000000000000221.
To compare behavior ratings of executive functioning in individuals with chronic kidney disease (CKD), using the Behavior Rating Inventory for Executive Functions (BRIEF), with a typically developing comparison group and to examine the correlation between disease severity and ratings of executive functioning.
Participants included 92 individuals with CKD (eGFR < 90 mL/min per 1.73 m), aged 8 to 25 years, recruited from nephrology clinics in both hospital and community settings. The disease severity ranged from CKD Stage II to V. The BRIEF was completed by parents for individuals younger than 18 years of age and the BRIEF-Adult was completed by individuals who were older than 18.
For individuals with CKD younger than 18 years of age, the parent-reported BRIEF revealed significant group differences when compared with controls on the Metacognition Index and the individual scales of Initiate, Working Memory, and Plan/Organize. A large proportion of individuals with CKD were rated as being at-risk for executive dysfunction. For the individuals of 18 years of age and older, there were no significant group differences. The relationship between BRIEF ratings and disease severity was limited to a few scales across both versions of the BRIEF.
This study supported the presence of executive dysfunction through a parent report, although the level of impairment was mild and its association with disease severity was related to select executive functions. Few difficulties were reported by older adolescents and young adults with CKD. It will be important for developmental-behavioral pediatricians to be cognizant of the level and pattern of executive function capabilities in their patients with CKD, and possible discrepancies with parent reports, so as to facilitate their management and transition planning.
使用执行功能行为评定量表（BRIEF），比较慢性肾脏病（CKD）患者与正常发育对照组在执行功能方面的行为评定结果，并研究疾病严重程度与执行功能评定之间的相关性。
研究对象包括92名年龄在8至25岁之间、估算肾小球滤过率（eGFR）<90 mL/（min·1.73 m²）的CKD患者，这些患者来自医院和社区的肾脏病诊所。疾病严重程度从CKDⅡ期到Ⅴ期。18岁以下患者由家长完成BRIEF量表，18岁以上患者完成BRIEF成人版量表。
对于18岁以下的CKD患者，家长报告的BRIEF量表显示，与对照组相比，在元认知指数以及启动、工作记忆和计划/组织等单项量表上存在显著的组间差异。很大一部分CKD患者被评定为有执行功能障碍风险。对于18岁及以上的患者，组间无显著差异。BRIEF量表评分与疾病严重程度之间的关系仅限于两个版本BRIEF量表的少数几个量表。
本研究通过家长报告证实了CKD患者存在执行功能障碍，尽管损伤程度较轻，且其与疾病严重程度的关联仅涉及部分执行功能。很少有年长青少年和年轻成人CKD患者报告存在困难。发育行为儿科医生了解CKD患者执行功能能力的水平和模式以及与家长报告可能存在的差异很重要，以便于患者的管理和过渡计划。
