Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO.
Division of Pediatric Nephrology, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA.
Semin Nephrol. 2021 Sep;41(5):446-454. doi: 10.1016/j.semnephrol.2021.09.007.
Pediatric chronic kidney disease (CKD) is associated with deficits in neurocognitive functioning, ranging from mild to severe, and correlated with the severity of kidney disease. Clinical variables that are associated with neurocognitive deficits include lower kidney function, hypertension, proteinuria, and metabolic acidosis. Commonly reported neurocognitive difficulties include academic underachievement and deficits in attention regulation and executive function as well as somewhat lower intellectual abilities compared with peer and normative data. Although often mild, these neurocognitive deficits may have broad implications for quality of life and likely contribute to both poorer high school graduation rates and long-term underemployment in the adult CKD population. The presence of neurocognitive deficits in predialytic CKD has been well characterized, but further longitudinal research is warranted to describe cognitive changes as children progress from early stage CKD to kidney replacement therapy. Such studies should include both cognitive and neuroimaging evaluations to better inform the impact of CKD progression on neurocognitive outcomes.
儿科慢性肾脏病（CKD）与神经认知功能障碍相关，从轻度到重度不等，并与肾脏疾病的严重程度相关。与神经认知缺陷相关的临床变量包括肾功能下降、高血压、蛋白尿和代谢性酸中毒。常见的神经认知困难包括学业成绩不佳、注意力调节和执行功能缺陷，以及与同龄人和正常数据相比智力稍低。尽管这些神经认知缺陷通常较轻，但它们可能对生活质量产生广泛影响，并可能导致透析前 CKD 人群高中辍学率和长期就业不足。在透析前 CKD 中存在神经认知缺陷已经得到很好的描述，但需要进一步的纵向研究来描述认知变化，因为儿童从早期 CKD 进展到肾脏替代治疗。这些研究应包括认知和神经影像学评估，以更好地了解 CKD 进展对神经认知结果的影响。
