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Increased history of ischemic stroke and decreased neurocognitive performance in children with chronic kidney disease

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Abstract

Background

This study aimed to determine stroke incidence and assess the association between stroke and neurocognitive functioning in children with chronic kidney disease (CKD).

Methods

Data was derived from the Chronic Kidney Disease in Children (CKiD) cohort study. Stroke incidence was calculated after confirming self-reports of stroke occurrence by chart review. Each participant with stroke was matched with three stroke-free participants and performance on selected neurocognitive measures was compared. Wilcoxon rank-sum tests were used to compare neurocognitive test scores. Effect size (ES) was estimated using a modified version of Cohen’s U3 metric that measures the excess percentage of the stroke group worse than the median of the control group.

Results

Of 891 subjects, five (0.56%) had a confirmed stroke prior to study entry. Median time at risk was 15.7 years [interquartile range, 12.5–18.4]. Estimated incidence rate of history of stroke was 36.8 per 100,000 children per year (95% confidence interval 15.3, 88.5). Controls and subjects with stroke were similar in age, CKD duration, race, and maternal education. ES for many of the neurocognitive comparisons was moderate to large. Subjects in the CKID cohort with a history of stroke had lower scores on spatial span reverse, spatial span forward, and design fluency, and worse parent ratings on BRIEF Metacognition Index compared to a matched sample of children with CKD without stroke.

Conclusions

Children with CKD have an increased incidence of prior ischemic stroke compared to the general pediatric population. A stroke history was associated with poorer performance on neurocognitive measures.

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Acknowledgments

Data reviewed in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri-Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health.

Funding

The CKiD is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-082194, and U01-DK66116).

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Authors and Affiliations

  1. Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA

    Juan C. Kupferman

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Matthew B. Matheson

  3. Department of Pediatrics, University of Rochester, Rochester, NY, USA

    Marc B. Lande

  4. Department of Pediatrics, Division of Nephrology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Joseph T. Flynn

  5. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan Furth

  6. Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

  7. Departments of Allied Health Sciences and Psychiatry, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA

    Stephen R. Hooper

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  1. Juan C. Kupferman
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Correspondence to Juan C. Kupferman.

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Kupferman, J.C., Matheson, M.B., Lande, M.B. et al. Increased history of ischemic stroke and decreased neurocognitive performance in children with chronic kidney disease. Pediatr Nephrol 35, 1315–1321 (2020). https://doi.org/10.1007/s00467-020-04503-9

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