Pediatric Nephrology

, Volume 32, Issue 11, pp 2027–2035 | Cite as

Cognitive remediation in pediatric chronic kidney disease and end-stage kidney disease: rationale, candidate interventions, and applicability

  • Karina Javalkar
  • Maria E. Ferris
  • Jessica Cuttance
  • Stephen R. Hooper
Educational Review


The purpose of this paper is to address the potential use of cognitive remediation interventions for children and adolescents with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The prevalence and risk for neurocognitive dysfunction in children with this condition remains high, but, to date, interventions targeting these challenges have not been attempted either individually or as part of a larger treatment program. This is the next logical step in addressing the neurocognitive dysfunction that can be present in pediatric CKD/ESKD, with the field needing to determine the efficacy of cognitive remediation approaches for this population. To our knowledge, this paper is the first to raise this possibility by identifying candidate treatments addressing the neurocognitive challenges observed in children and adolescents with CKD/ESKD. Initially, we present the rationale for the importance of addressing the cognitive difficulties in this population, including an overview of the literature documenting the neurocognitive deficits associated with pediatric-onset CKD/ESKD. This is followed by a review of five candidate cognitive remediation programs that may be applicable to patients with this condition, and associated factors that could affect such treatment. The paper concludes with suggestions for both clinical and research initiatives that could be implemented to examine cognitive remediation as potential components of a larger treatment program for children and adolescents with CKD/ESKD.


CKD Cognition Cognitive dysfunction Pediatric-onset CKD Cognitive remediation Cognitive rehabilitation 


  1. 1.
    Shaw CA, Lanius RA, van den Doel K (1994) The origin of synaptic neuroplasticity: crucial molecules or a dynamical cascade? Brain Res Rev 19:241–263CrossRefPubMedGoogle Scholar
  2. 2.
    Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, Laatsch L, Morse PA, Catanese J (2005) Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil 86:1681–1692CrossRefPubMedGoogle Scholar
  3. 3.
    Karch D, Albers L, Renner G, Lichtenauer N, von Kries R (2013) The efficacy of cognitive training programs in children and adolescents: a meta-analysis. Dtsch Arztebl Int 110:643–652PubMedPubMedCentralGoogle Scholar
  4. 4.
    Rohling ML, Faust ME, Beverly B, Demakis G (2009) Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone, et al’.s (2000, 2005) systematic reviews. Neuropsychology 23:20–39CrossRefPubMedGoogle Scholar
  5. 5.
    Sturm W (2010) Evidenzbasierte Verfahren in der neuropsychologischen Rehabilitation: Therapie von Aufmerksamkeitsstörungen. Neuro Rehabil 16:55–62Google Scholar
  6. 6.
    Naismith SL, Redoblado-Hodge MA, Lewis SJG, Scott EM, Hickie IB (2010) Cognitive training in affective disorders improved memory: a preliminary study using the NEAR approach. J Affect Disord 121:258–262CrossRefPubMedGoogle Scholar
  7. 7.
    Evans SW, Owens J, Bunford MN (2014) Evidence-based psychosocial treatments for children and adolescents with Attention-Deficit/Hyperactivity Disorder. J Clin Child Adolesc Psychol 43:527–551CrossRefPubMedGoogle Scholar
  8. 8.
    Mendley SR, Matheson MB, Shinnar S, Lande MB, Gerson AC, Butler RW, Warady BA, Furth SL, Hooper SR (2015) Duration of chronic kidney disease reduces attention and executive function in pediatric patients. Kidney Int 87:800–806CrossRefPubMedGoogle Scholar
  9. 9.
    Wong CJ, Moxey-Mimms M, Jerry-Fluker J, Warady BA, Furth SL (2012) CKiD (CKD in children) prospective cohort study: a review of current findings. Am J Kid Disord 60:1002–1011CrossRefGoogle Scholar
  10. 10.
    Gerson AC, Butler R, Moxey-Mims M, Wentz A, Shinnar S, Lande MB, Mendley SR, Warady BA, Furth SL, Hooper SR (2006) Neurocognitive outcomes in children with chronic kidney disease: current findings and contemporary endeavors. Ment Retard Dev Disabil Res Rev 12:208–215CrossRefPubMedGoogle Scholar
  11. 11.
    Gipson DS, Duquette PJ, Icard PF, Hooper SR (2007) The central nervous system in childhood chronic kidney disease. Pediatr Nephrol 22:1703–1710CrossRefPubMedGoogle Scholar
  12. 12.
    Hooper SR, Gerson AC, Butler RW, Gipson DS, Mendley SR, Lande MB, Shinnar S, Wentz A, Matheson M, Cox C, Furth SL, Warady BA (2011) Neurocognitive functioning of children and adolescents with mild-to-moderate chronic kidney disease. Clin J Am Soc Nephrol 6:1824–1830CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hooper SR, Gerson AC, Johnson RJ, Mendley SR, Shinnar S, Lande MB, Matheson MB, Gipson DS, Morgenstern B, Warady BA, Furth SL (2016) Neurocognitive, social-behavioral, and adaptive functioning in preschool children with mild to moderate kidney disease. J Dev Behav Pediatr 37:231–238CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lande MB, Gerson AC, Hooper SR, Cox C, Matheson M, Mendley SR, Gipson DS, Wong C, Warady BA, Furth SL, Flynn JT (2011) Casual blood pressure and neurocognitive function in children with chronic kidney disease: a report of the children with chronic kidney disease cohort study. Clin J Am Soc Nephrol 6:1831–1837CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Duquette PJ, Hooper SR, Wetherington CE, Icard PF, Gipson DS (2007) Brief report: intellectual and academic functioning in pediatric chronic kidney disease. J Pediatr Psychol 32:1011–1017CrossRefPubMedGoogle Scholar
  16. 16.
    Hooper SR, Laney N, Radcliffe J, Moodalbail D, Hartung EA, Ruebner RL, Jawad AF, Furth SL (2015) Executive functioning in children, adolescents, and young adults with chronic kidney disease. J Dev Behav Pediatr 36:734–742CrossRefPubMedGoogle Scholar
  17. 17.
    Gipson DS, Hooper SR, Duquette PJ, Wetherington CE, Stellwagen KK, Jenkins TL, Ferris ME (2006) Memory and executive functions in pediatric chronic kidney disease. Child Neuropsychol 12:391–405CrossRefPubMedGoogle Scholar
  18. 18.
    Warady BA, Abraham AG, Schwartz GJ, Wong CS, Munoz A, Betoko A, Mitsnefes M, Kaskel F, Greenbaum LA, Mak RH, Flynn J, Moxey-Mims M, Furth S (2015) Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: the chronic kidney disease in children (CKiD) cohort. Am J Kidney Dis 65:878–888CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Massengill SF, Ferris M (2014) Chronic kidney disease in children and adolescents. Pediatr Rev 35:16–29CrossRefPubMedGoogle Scholar
  20. 20.
    Kurella M, Chertow GM, Luan J, Yaffe K (2004) Cognitive impairment in chronic kidney disease. J Am Geriatr Soc 52:1863–1869CrossRefPubMedGoogle Scholar
  21. 21.
    Moodalbail DG, Reiser KA, Detre JA, Schultz RT, Herrington JD, Davatzikos C, Doshi JJ, Erus G, Liu HS, Radcliffe J, Furth SL, Hooper SR (2013) Systematic review of structural and functional neuroimaging findings in children and adults with CKD. Clin J Am Soc Nephrol 8:1429–1448CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Brouhard BH, Donaldson LA, Lawry KW, McGowan KR, Drotar D, Davis I, Rose S, Cohn RA, Tejani A (2000) Cognitive functioning in children on dialysis and post-transplantation. Pediatr Transplant 4:261–267CrossRefPubMedGoogle Scholar
  23. 23.
    Haavisto A, Korkman M, Holmberg C, Jalanko H, Qvist E (2012) Neuropsychological profile of children with kidney transplants. Nephrol Dial Transplant 27:2594–2601CrossRefPubMedGoogle Scholar
  24. 24.
    Groothoff JW, Gruppen MP, Offringa M, de Groot E, Stok W, Bos WJ, Davin JC, Lilien MR, Van DK, Wolff ED, Heymans HS (2002) Increased arterial stiffness in young adults with end-stage renal disease since childhood. J Am Soc Nephrol 13:2953–2961CrossRefPubMedGoogle Scholar
  25. 25.
    Slickers J, Duquette P, Hooper S, Gipson D (2007) Clinical predictors of neurocognitive deficits in children with chronic kidney disease. Pediatr Nephrol 22:565–572CrossRefPubMedGoogle Scholar
  26. 26.
    Etgen T, Chonchol M, Forstl H, Sander D (2012) Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol 35:474–482CrossRefPubMedGoogle Scholar
  27. 27.
    US Renal Data System (2014) USRDS 2014 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United StatesGoogle Scholar
  28. 28.
    Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP (2010) Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis 56:693–703CrossRefPubMedGoogle Scholar
  29. 29.
    Ferris ME, Gipson DS, Kimmel PL, Eggers PW (2006) Trends in treatment and outcomes of survival of adolescents initiating end-stage renal disease care in the United States of America. Pediatr Nephrol 21:1020–1026CrossRefPubMedGoogle Scholar
  30. 30.
    Shaw SR, McCabe PC (2008) Hospital‐to‐school transition for children with chronic illness: meeting the new challenges of an evolving health care system Pscyhol Sch 45:74–87Google Scholar
  31. 31.
    Steiner NJ, Sheldrick RC, Gotthelf D, Perrin EC (2011) Computer-based attention training in the schools for children with attention deficit/hyperactivity disorder: a preliminary trial. Clin Pediatr 50:615–622CrossRefGoogle Scholar
  32. 32.
    Beck SJ, Hanson CA, Puffenberger SS, Benninger KL, Benninger WB (2010) A controlled trial of working memory training for children and adolescents with ADHD. J Clin Child Adolesc 39:825–836CrossRefGoogle Scholar
  33. 33.
    Gibson BS, Gondoli DM, Johnson AC, Steeger CM, Dobrzenski BA, Morrissey RA (2011) Component analysis of verbal versus spatial working memory training in adolescents with ADHD: a randomized, controlled trial. Child Neuropsychol 17:546–563CrossRefPubMedGoogle Scholar
  34. 34.
    Thorell LB, Lindqvist S, Bergman Nutley S, Bohlin G, Klingberg T (2009) Training and transfer effects of executive functions in preschool children. Dev Sci 12:106–113CrossRefPubMedGoogle Scholar
  35. 35.
    Spencer-Smith M, Klingberg T (2015) Benefits of a working memory training program for inattention in daily life: a systematic review and meta-analysis. PLoS One 10:e0119522CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Butler RW, Copeland DR, Fairclough DL, Mulhern RK, Katz ER, Kazak AE, Noll RB, Patel SK, Sahler OJ (2008) A multicenter, randomized clinical trial of a cognitive remediation program for childhood survivors of a pediatric malignancy. J Consult Clin Psychol 76:367–378CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Van’t Hooft I, Andersson K, Sejersen T, Bartfai A, von Wendt L (2003) Attention and memory training in children with acquired brain injuries. Acta Paediatr 92:935–940Google Scholar
  38. 38.
    Sjo NM, Spellerberg S, Weidner S, Kihlgren M (2010) Training of attention and memory deficits in children with acquired brain injury. Acta Paediatr 99:230–236CrossRefPubMedGoogle Scholar
  39. 39.
    Harrell W, Eack S, Hooper SR, Keshavan MS, Bonner MS, Schoch K, Shashi V (2013) Feasibility and preliminary efficacy data from a computerized cognitive intervention in children with chromosome 22q11.2 deletion syndrome. Res Dev Disabil 34:2606–2613CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Hill OW, Seprell Z, Faison MO (2016) The efficacy of the LearningRx cognitive training program: modality and transfer effects. J Exp Educ 84:1–21CrossRefGoogle Scholar
  41. 41.
    Ikezawa S, Mogami T, Hayami Y, Sato I, Kato T, Kimura I, Pu S, Kaneko K, Nakagome K (2012) The pilot study of a Neuropsychological Educational Approach to Cognitive Remediation for patients with schizophrenia in Japan. Psychiatry Res 195:107–110CrossRefPubMedGoogle Scholar
  42. 42.
    Kang S, Kim D, Seo K, Choi K, Yoo J, Sung S, Park H (2009) A computerized visual perception rehabilitation programme with interactive computer interface using motion tracking technology—a randomized controlled, single-blinded, pilot clinical trial study. Clin Rehabil 23:434–444CrossRefGoogle Scholar
  43. 43.
    Rabiner DL, Murray DW, Rosen L, Skinner A, Malone PS (2010) A randomized trial of two promising computer-based interventions for students with attention difficulties. J Abnorm Child Psychol 38:131–142CrossRefPubMedGoogle Scholar
  44. 44.
    Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW, Holtmann M, Santosh P, Stevenson J, Stringaris A, Zuddas A, Sonuga-Barke EJS (2015) Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry 54:164–174CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Butler RW, Copeland DR (2002) Attentional processes and their remediation in children treated for cancer: a literature review and the development of a therapeutic approach. J Int Neuropsychol Soc 8:115–124CrossRefPubMedGoogle Scholar
  46. 46.
    Van’t Hooft I, Andersson K, Bergman B, Sejersen T, Von Wendt L, Bartfai A (2005) Beneficial effect from a cognitive training programme on children with acquired brain injuries demonstrated in a controlled study. Brain Inj 19:511–518Google Scholar
  47. 47.
    So TY, Layton JB, Bozik K, Farrington E, Gipson PE, Gibson K, Primack W, Conley W, Gipson DS, Ferris M (2011) Cognitive pharmacy services at a pediatric nephrology and hypertension clinic. Ren Fail 33:19–25CrossRefPubMedGoogle Scholar
  48. 48.
    Blydt-Hansen TD, Pierce CB, Cai Y, Samsonov D, Massengill S, Moxey-Mims M, Warady BA, Furth SL (2014) Medication treatment complexity and adherence in children with CKD. Clin J Am Soc Nephrol 9:247–254CrossRefPubMedGoogle Scholar
  49. 49.
    Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, Gillberg CG, Forssberg H, Westerberg H (2005) Computerized training of working memory in children with ADHD—a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 44:177–186CrossRefPubMedGoogle Scholar
  50. 50.
    Hulme C, Melby-Lervåg M (2012) Current evidence does not support the claims made for CogMed working memory training. J Appl Res Mem Cog 1:197–200CrossRefGoogle Scholar
  51. 51.
    Shinaver CS 3rd, Entwistle PC, Soderqvist S (2014) Cogmed WM training: reviewing the reviews. Appl Neuropsychol Child 3:163–172CrossRefPubMedGoogle Scholar
  52. 52.
    Shipstead Z, Hicks KL, Engle RW (2012) Cogmed working memory training: does the evidence support the claims? J Appl Res Mem Cog 1:185–193CrossRefGoogle Scholar
  53. 53.
    Ferris ME, Ferris MT, Okumura MJ, Cohen SE, Hooper SR (2015) Health care transition preparation in youth with chronic conditions: working towards translational evidence with a patient perspective. J Pediatr Rehabil Med 8:31–37PubMedGoogle Scholar
  54. 54.
    Ferris ME, Cuttance JR, Javalkar K, Cohen SE, Phillips A, Bickford K, Gibson K, Ferris MT, True K (2015) Self-management and transition among adolescents/young adults with chronic or end-stage kidney disease. Blood Purif 39:99–104CrossRefPubMedGoogle Scholar
  55. 55.
    U.S. Renal Data System (USRDS) (2009) Chronic kidney disease in the adult NHANES population. 2009 ASRDS Annual Report Data. Accessed 20 January 2017
  56. 56.
    Fraser SDS, Roderick PJ, May CR, McIntyre N, McIntyre C, Fluck RJ, Shardlow A, Taal MW (2015) The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC Nephrol 16:193–203CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© IPNA 2017

Authors and Affiliations

  • Karina Javalkar
    • 1
  • Maria E. Ferris
    • 1
  • Jessica Cuttance
    • 1
  • Stephen R. Hooper
    • 1
  1. 1.School of MedicineUniversity of North Carolina-Chapel HillChapel HillUSA

Personalised recommendations