Neurocognitive and Educational Outcomes in Children and Adolescents with CKD A Systematic Review and Meta-Analysis

Kerry Chen, Madeleine Didsbury, Anita van Zwieten, Martin Howell, Siah Kim, Allison Tong, Kirsten Howard, Natasha Nassar, Belinda Barton, Suncica Lah, Jennifer Lorenzo, Giovanni Strippoli, Suetonia Palmer, Armando Teixeira-Pinto, Fiona Mackie, Steven McTaggart, Amanda Walker, Tonya Kara, Jonathan Craig, Germaine Wong

Research output: Contribution to journalReview articlepeer-review

66 Citations (Scopus)


Background and objectives Poor cognition can affect educational attainment, but the extent of neurocognitive impairment in children with CKD is not well understood. This systematic review assessed global and domain-specific cognition and academic skills in children with CKD and whether these outcomes varied with CKD stage. Design, setting, participants, & measurements Electronic databases were searched for observational studies of children with CKD ages 21 years old or younger that assessed neurocognitive or educational outcomes. Risk of bias was assessed using a modified Newcastle–Ottawa scale. We used random effects models and expressed the estimates as mean differences with 95% confidence intervals stratified by CKD stage. Results Thirty-four studies (25 cross-sectional, n=2095; nine cohort, n=991) were included. The overall risk of bias was high because of selection and measurement biases. The global cognition (full-scale intelligence quotient) of children with CKD was classified as low average. Compared with the general population, the mean differences (95% confidence intervals) in full-scale intelligence quotient were 210.5 (95% confidence interval, 213.2 to 27.72; all CKD stages, n=758), 29.39 (95% confidence interval, 212.6 to 26.18; mild to moderate stage CKD, n=582), 216.2 (95% confidence interval, 233.2 to 0.86; dialysis, n=23), and 211.2 (95% confidence interval, 217.8 to 24.50; transplant, n=153). Direct comparisons showed that children with mild to moderate stage CKD and kidney transplants scored 11.2 (95% confidence interval, 2.98 to 19.4) and 10.1 (95% confidence interval, 21.81 to 22.0) full-scale intelligence quotient points higher than children on dialysis. Children with CKD also had lower scores than the general population in executive function and memory (verbal and visual) domains. Compared with children without CKD, the mean differences in academic skills (n=518) ranged from 215.7 to 21.22 for mathematics, from 29.04 to 20.17 for reading, and from 214.2 to 2.53 for spelling. Conclusions Children with CKD may have low-average cognition compared with the general population, with mild deficits observed across academic skills, executive function, and visual and verbal memory. Limited evidence suggests that children on dialysis may be at greatest risk compared with children with mild to moderate stage CKD and transplant recipients.

Original languageEnglish
Pages (from-to)387-397
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Issue number3
Publication statusPublished - 7 Mar 2018


  • Adolescent
  • Bias
  • Child
  • Chronic kidney disease
  • Cognition
  • Cohort Studies
  • Confidence Intervals
  • Cross-Sectional Studies
  • Dialysis
  • Education
  • Epidemiology and outcomes
  • Executive Function
  • Humans
  • Intelligence
  • Kidney transplantation
  • Mathematics
  • Memory
  • Neurocognition
  • Pediatrics
  • Reading
  • Renal Insufficiency, Chronic
  • Transplant outcomes
  • Transplant Recipients


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