Attention Functions in Children with Pediatric Chronic Kidney Disease

Children with chronic kidney disease (CKD) can evidence a variety of general and specific neurocognitive deficits, but little is known regarding the effects of pediatric CKD on specific domains of attention. Using a variety of measures tapping specific domains (e.g., Focus/Execute, Sustain, Stability, Shift, Encode), the current study compared attention outcomes for school-age children with CKD to those of a typicallydeveloping control group. The study addressed the following research questions: 1) Do specific domains of attention in children and adolescents with CKD differ significantly from those measured in typically-developing children and adolescents? 2) Do pediatric patients with CKD differ significantly from typically-developing children in their observed proportion of attention problems? 3) What functional- (e.g., recent school absences, IQ), family- (e.g., socioeconomic status), and disease-related (e.g., disease severity, age of onset, duration of disease) characteristics predict attention domain scores? Significant differences on group means were revealed between the CKD (n = 30) and control (n = 41) groups on the Focus/Execute, Sustain, Stability, and Encode attention domains; no group differences were evident on the Shift domain. The CKD group also had a larger proportion of children with attention domain scores one standard deviation or more below the mean on the Shift and Encode domains. The CKD and iv control groups did not differ with respect to the proportion of scores falling one standard deviation or more below the mean on the Focus/Execute, Sustain, or Shift domains. Correlational data indicated that IQ scores and socioeconomic status were positively correlated with all five attention domains, while disease severity was negatively correlated with the attention domains. Exploratory regression analyses indicated that IQ scores were a significant predictor of the Stability and Encode attention domains. No predictors emerged for the Focus/Execute, Sustain, or Shift attention domains. In exploratory analyses with a subdivided CKD group, the end-stage renal disease (ESRD, i.e., kidney failure) group was found to have a higher proportion of attention scores one standard deviation or more below the mean on the Focus/Execute, Sustain, and Stability domains. Exploratory univariate comparisons of children with ESRD versus those with mild/moderate CKD further suggested a potential effect of disease severity on attention. Findings suggested that children with CKD may be vulnerable to subtle, specific deficits in domains of attention relative to their typically-developing peers. Results also suggested that this finding of specific attention problems may be particularly relevant for children with more severe levels of CKD. Facets of the current study, such as small sample size and other limitations, precluded broad generalizations of these findings to the pediatric CKD population as a whole. Future research should utilize regression analyses to develop a model of risk using predictor variables when screening for neurocognitive deficits. Using larger sample sizes and longitudinal analyses in future research may help to distinguish subtle attention problems in this population. Limitations and suggestions for future research are discussed