Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pediatr Nephrol. 2020 Jul;35(7):1315-1321. doi: 10.1007/s00467-020-04503-9. Epub 2020 Feb 24.
This study aimed to determine stroke incidence and assess the association between stroke and neurocognitive functioning in children with chronic kidney disease (CKD).
Data was derived from the Chronic Kidney Disease in Children (CKiD) cohort study. Stroke incidence was calculated after confirming self-reports of stroke occurrence by chart review. Each participant with stroke was matched with three stroke-free participants and performance on selected neurocognitive measures was compared. Wilcoxon rank-sum tests were used to compare neurocognitive test scores. Effect size (ES) was estimated using a modified version of Cohen's U metric that measures the excess percentage of the stroke group worse than the median of the control group.
Of 891 subjects, five (0.56%) had a confirmed stroke prior to study entry. Median time at risk was 15.7 years [interquartile range, 12.5-18.4]. Estimated incidence rate of history of stroke was 36.8 per 100,000 children per year (95% confidence interval 15.3, 88.5). Controls and subjects with stroke were similar in age, CKD duration, race, and maternal education. ES for many of the neurocognitive comparisons was moderate to large. Subjects in the CKID cohort with a history of stroke had lower scores on spatial span reverse, spatial span forward, and design fluency, and worse parent ratings on BRIEF Metacognition Index compared to a matched sample of children with CKD without stroke.
Children with CKD have an increased incidence of prior ischemic stroke compared to the general pediatric population. A stroke history was associated with poorer performance on neurocognitive measures. Graphical abstract.
本研究旨在确定慢性肾脏病（CKD）儿童的中风发病率，并评估中风与神经认知功能之间的关系。
数据来自慢性肾脏病儿童（CKiD）队列研究。通过病历审查确认中风发生的自我报告后，计算中风发病率。每个中风患者都与 3 名无中风患者相匹配，并比较了所选神经认知测量的表现。Wilcoxon 秩和检验用于比较神经认知测试分数。使用 Cohen 的 U 度量的修改版本估计效应量（ES），该度量衡量中风组比对照组中位数差的多余百分比。
在 891 名受试者中，有 5 名（0.56%）在研究入组前确诊为中风。风险中位时间为 15.7 年[四分位距（IQR）12.5-18.4]。估计中风史的发病率为每年每 10 万名儿童 36.8 例（95%置信区间 15.3，88.5）。对照组和中风组在年龄、CKD 持续时间、种族和母亲教育方面相似。许多神经认知比较的 ES 为中等到较大。与无中风的 CKD 儿童匹配样本相比，CKiD 队列中有中风史的儿童在空间跨度反转、空间跨度前进和设计流畅性方面的得分较低，BRIEF 元认知指数的父母评分也较差。
与一般儿科人群相比，CKD 儿童的缺血性中风发病率增加。中风史与神经认知测量表现较差相关。
