Casual Blood Pressure and Neurocognitive Function in Children with Chronic Kidney Disease: A Report of the Children with Chronic Kidney Disease Cohort Study

• Published in: Clinical journal of the American Society of Nephrology 2011-08, Vol.6 (8), p.1831-1837
• Main Authors: Lande, Marc B, Gerson, Arlene C, Hooper, Stephen R, Cox, Christopher, Matheson, Matt, Mendley, Susan R, Gipson, Debbie S, Wong, Cynthia, Warady, Bradley A, Furth, Susan L, Flynn, Joseph T
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Behavior; Attention; Blood Pressure; Child; Child Behavior; Chronic Disease; Cognition; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Cognition Disorders - physiopathology; Cognition Disorders - psychology; Cohort Studies; Cross-Sectional Studies; Educational Status; Executive Function; Female; Glomerular Filtration Rate; Humans; Hypertension - diagnosis; Hypertension - etiology; Hypertension - physiopathology; Hypertension - psychology; Intelligence; Intelligence Tests; Kidney - physiopathology; Kidney Diseases - complications; Kidney Diseases - diagnosis; Kidney Diseases - physiopathology; Kidney Diseases - psychology; Linear Models; Male; Neuropsychological Tests; North America; Original; Risk Assessment; Risk Factors
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.00810111

Children with chronic kidney disease (CKD) are at risk for cognitive dysfunction, and over half have hypertension. Data on the potential contribution of hypertension to CKD-associated neurocognitive deficits in children are limited. Our objective was to determine whether children with CKD and elevated BP (EBP) had decreased performance on neurocognitive testing compared with children with CKD and normal BP. This was a cross-sectional analysis of the relation between auscultatory BP and neurocognitive test performance in children 6 to 17 years enrolled in the Chronic Kidney Disease in Children (CKiD) project. Of 383 subjects, 132 (34%) had EBP (systolic BP and/or diastolic BP ≥90(th) percentile). Subjects with EBP had lower mean (SD) scores on Wechsler Abbreviated Scales of Intelligence (WASI) Performance IQ than those with normal BP (normal BP versus EBP, 96.1 (16.7) versus 92.4 (14.9), P = 0.03) and WASI Full Scale IQ (97.0 (16.2) versus 93.4 (16.5), P = 0.04). BP index (subject's BP/95(th) percentile BP) correlated inversely with Performance IQ score (systolic, r = -0.13, P = 0.01; diastolic, r = -0.19, P < 0.001). On multivariate analysis, the association between lower Performance IQ score and increased BP remained significant after controlling for demographic and disease-related variables (EBP, β = -3.7, 95% confidence interval [CI]: -7.3 to -0.06; systolic BP index, β = -1.16 to 95% CI: -2.1, -0.21; diastolic BP index, β = -1.17, 95% CI: -1.8 to -0.55). Higher BP was independently associated with decreased WASI Performance IQ scores in children with mild-to-moderate CKD.