Association Between Chronic Kidney Disease-Mineral Bone Disease (CKD-MBD) and Cognition in Children: Chronic Kidney Disease in Children (CKiD) Study

被引:9
|
作者
Yokoyama, Jennifer S. [1 ,2 ]
Matsuda-Abedini, Mina [3 ]
Denburg, Michelle R. [4 ]
Kumar, Juhi [5 ]
Warady, Bradley A. [6 ]
Furth, Susan L. [4 ]
Hooper, Stephen R. [7 ]
Portale, Anthony A. [8 ]
Perwad, Farzana [8 ]
机构
[1] Univ Calif San Francisco, Dept Neurol, Memory & Aging Ctr, San Francisco, CA 94158 USA
[2] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA 94158 USA
[3] Univ Toronto, Hosp Sick Children, Div Nephrol, Toronto, ON, Canada
[4] Univ Penn, Childrens Hosp Philadelphia, Div Nephrol, Perelman Sch Med, Philadelphia, PA 19104 USA
[5] Weill Cornell Med Coll, Div Nephrol, New York, NY USA
[6] Childrens Mercy Kansas City, Div Nephrol, Kansas City, MO USA
[7] Univ North Carolina Chapel Hill, Dept Allied Hlth Sci, Sch Med, Chapel Hill, NC USA
[8] Univ Calif San Francisco, Dept Pediat, Div Nephrol, San Francisco, CA 94158 USA
基金
美国国家卫生研究院;
关键词
FIBROBLAST-GROWTH-FACTOR; VITAMIN-D METABOLISM; STAGE RENAL-DISEASE; BLOOD-PRESSURE; FGF23; ADOLESCENTS; FIBROBLAST-GROWTH-FACTOR-23; PROGRESSION; MORTALITY; OUTCOMES;
D O I
10.1016/j.xkme.2020.03.005
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Rationale & Objective: Chronic kidney disease (CKD) in children is associated with cognitive dysfunction that affects school performance and quality of life. The relationship between CKD-mineral and bone disorder and cognitive function in children is unknown. Study Design: Observational study. Participants: 702 children enrolled in the Chronic Kidney Disease in Children (CKiD) Study. Predictors: Plasma fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), calcium, phosphorus, 25 hydroxyvitamin D (25[OH]D), and 1,25 dihydroxyvitamin D (1,25[OH](2)D). Outcomes: Neurocognitive tests of intelligence, academic achievement, and executive functions. Analytical Approach: Linear regression models to analyze the cross-sectional associations between log(2)FGF-23, 25(OH)D, 1,25(OH)(2)D, PTH, calcium, and phosphorus z scores and the cognitive test scores of interest after adjustment for demographics, blood pressure, proteinuria, and kidney function. Results: At baseline, median age was 12 (95% CI, 8.3, 15.2) years and estimated glomerular filtration rate was 54 (40.5, 67.8) mL/min/1.73 m(2). In fully adjusted analyses, 25(OH)D, 1,25(OH)(2)D, PTH, calcium, and phosphorus z scores did not associate with cognitive test scores. In fully adjusted analyses, log(2)FGF-23 was associated with abnormal test scores for attention regulation (P < 0.05); specifically, Conners' Continuous Performance Test II Errors of Omission (beta = 2.3 [1.0, 3.6]), Variability (beta = 1.4 [0.4, -2.4]), and Hit Reaction Time (beta = 1.3 [0.2, 2.4]). Children in the highest FGF-23 tertile group had 7% and 9% greater cognitive risk for Hit Reaction Time and Errors of Omission compared with those in the lowest tertile, respectively. In fully adjusted analyses, higher FGF-23 tertile was associated with increased cognitive risk (P < 0.05) for Errors of Omission (beta = 0.4 [0.1, 0.7]) and Hit Reaction Time (beta = 0.4 [0.1, 0.7]). Limitations: The study does not assess the cumulative effects of FGF-23 excess on cognitive function over time. Within-population stratified analyses were not performed due to limited sample size. Conclusions: In children with CKD, higher plasma FGF-23 level is associated with lower performance in targeted tests of executive function, specifically attention regulation, independent of glomerular filtration rate.
引用
收藏
页码:398 / 406
页数:9
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