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Depression and neurocognitive dysfunction in pediatric and young adult chronic kidney disease

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Abstract

Background

Depression affects 7–35% of children with chronic kidney disease (CKD), and in adults with CKD, the presence of depression links to poorer medical outcomes, social functioning difficulties, and neurocognitive impairments. The relationship between depression and neurocognitive function in youth with CKD is unclear. We sought to identify factors associated with depression in youth with CKD and to determine whether depression affects neurocognitive performance.

Methods

We conducted cross-sectional analyses in 71 CKD and 64 control participants aged 8 to 25 years who completed depression inventories and neurocognitive assessments as part of the Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with CKD Study. In the CKD group, multivariable logistic regression analysis determined associations between clinical and demographic factors and depression. In the full study cohort, multivariable linear regression analyses, including an interaction term between CKD status and depression evaluated the effect of depression on 11 neurocognitive outcome domains.

Results

Obesity significantly associated with depression in the CKD group (OR 10.25, P = 0.01). In adjusted analyses, depressed youth with CKD scored worse than non-depressed CKD participants by 0.6–1.0 standard deviations in 5 neurocognitive domains: attention, visual memory, visual-spatial, visual working memory, and problem solving.

Conclusions

CKD youth with obesity are more likely to be depressed, and those who are depressed exhibit worse neurocognitive performance. Depression may represent a therapeutic target to improve neurocognitive performance in youth with CKD.

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Abbreviations

(CKD):

Chronic kidney disease

(CKiD):

Chronic kidney disease in children

(GFR):

Glomerular filtration rate

(NiCK):

The Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease

(eGFRs):

Estimated GFRs

(MDRD):

Modification of diet in renal disease

(CDI-II):

Children’s Depression Inventory-II

(BDI-II):

Beck Depression Inventory-II

(WASI):

Wechsler Abbreviated Scales of Intelligence

(CPT-II):

Conners’ Continuous Performance Test-II

(WISC-IV-I):

Wechsler Intelligence Scale for Children Fourth Edition Integrated

(WMS-III):

Wechsler Memory Scale Third Edition

(BRIEF):

Executive functioning Behavior Rating Inventory of Executive Function

(D-KEFS):

Delis-Kaplan Executive Function System

(ESRD):

End-stage renal disease

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Funding source

This project was funded in part under a Commonwealth Universal Research Enhancement grant with the Pennsylvania Department of Health, no. SAP 4100054843. The Department specifically disclaims responsibility for any analyses, interpretations, or conclusions. The funders did not have any role in study design, data collection, data analysis, writing of the report, or the decision to submit the report for publication.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Author information

Authors and Affiliations

  1. Division of Nephrology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19103, USA

    Amy J. Kogon, Susan L. Furth & Erum A. Hartung

  2. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Amy J. Kogon, Jerilynn Radcliffe, Susan L. Furth & Erum A. Hartung

  3. Biostatistics Core, the Center for Human Phenomic Science, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Ji Young Kim

  4. Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Nina Laney

  5. Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jerilynn Radcliffe

  6. Department of Allied Health Sciences, School of Medicine University of North Carolina Chapel Hill, Chapel Hill, NC, USA

    Stephen R. Hooper

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  1. Amy J. Kogon
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  2. Ji Young Kim
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  3. Nina Laney
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  6. Susan L. Furth
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  7. Erum A. Hartung
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Corresponding author

Correspondence to Amy J. Kogon.

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The Institutional Review Board at the Children’s Hospital of Philadelphia (CHOP) approved this study, and informed consent was obtained from all participants.

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The authors declare that they have no conflict of interest.

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Additional information

An abstract of this data was presented as a poster at the American Society of Pediatric Nephrology 2018 Annual Meeting in Toronto Canada.

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Kogon, A.J., Kim, J.Y., Laney, N. et al. Depression and neurocognitive dysfunction in pediatric and young adult chronic kidney disease. Pediatr Nephrol 34, 1575–1582 (2019). https://doi.org/10.1007/s00467-019-04265-z

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