Journal article
Bicarbonate, blood pressure, and executive function in pediatric CKD-is there a link?
Pediatric nephrology (Berlin, West), Vol.35(7), pp.1323-1330
07/2020
DOI: 10.1007/s00467-020-04507-5
PMCID: PMC8077226
PMID: 32297000
Abstract
In adult chronic kidney disease (CKD), metabolic acidosis is associated with diminished cognition, notably executive function (EF). Data from the Chronic Kidney Disease in Children (CKiD) study demonstrate a risk for impairment of EF, a finding associated with heightened blood pressure variability (BPV). We sought to determine whether low serum bicarbonate is also associated with performance on tests of EF in pediatric CKD and to investigate potential interaction with BPV.
CKiD participants with serum bicarbonate, blood pressure, and selected cognitive measurements available were evaluated. An EF summary score was derived from scores on the Delis-Kaplan Executive Function System, Conners' Continuous Performance Test, and Digit Span Backwards subtest from the Wechsler Intelligence Scale for Children-IV-Integrated. Parents completed the Behavioral Rating Inventory of Executive Function (BRIEF) to yield a Global Executive Composite (GEC) score. Linear mixed models with bicarbonate and hypertension as predictors and linear regression with bicarbonate and BPV were used to predict EF level.
Data were available for 865 children. Twenty-two percent had low bicarbonate (CO
≤ 20 mmol/L) at baseline. On multivariate analysis, there was no relationship between bicarbonate, hypertension, and EF. There was no significant CO
×hypertension interaction found. A significant interaction (p = 0.01) between high CO
(≥ 26 mmol/L) and BPV was detected in the model with GEC as the EF outcome, indicating that while higher BPV was associated with worse EF in the low and normal CO
groups, higher BPV was associated with better EF in the high CO
group.
Our analyses revealed an interaction between one measure of BPV and low bicarbonate on neurocognition in pediatric CKD, suggesting a potential role for control of both bicarbonate and blood pressure in preserving cognition in early CKD. Further research is needed to confirm and further define this association.
Details
- Title: Subtitle
- Bicarbonate, blood pressure, and executive function in pediatric CKD-is there a link?
- Creators
- Lyndsay A Harshman - Division of Pediatric Nephrology, University of Iowa Stead Family Department of Pediatrics, 4037 Boyd Tower, 200 Hawkins Drive, Iowa City, IA, 52242, USA. lyndsay-harshman@uiowa.eduAmy J Kogon - Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USAMatthew B Matheson - Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USARebecca J Johnson - Division of Developmental and Behavioral Health, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, MO, USAShlomo Shinnar - Departments of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY, USAArlene C Gerson - Johns Hopkins University School of Medicine, Baltimore, MD, USABradley A Warady - Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USASusan L Furth - Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USAStephen R Hooper - Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USAMarc B Lande - University of Rochester Medical Center, Rochester, NY, USA
- Resource Type
- Journal article
- Publication Details
- Pediatric nephrology (Berlin, West), Vol.35(7), pp.1323-1330
- DOI
- 10.1007/s00467-020-04507-5
- PMID
- 32297000
- PMCID
- PMC8077226
- NLM abbreviation
- Pediatr Nephrol
- ISSN
- 0931-041X
- eISSN
- 1432-198X
- Publisher
- Germany
- Grant note
- K23DK110443 / NIDDK NIH HHS K23 DK110443 / NIDDK NIH HHS U01-DK-66116 / NIH HHS U01 DK066143 / NIDDK NIH HHS U01-DK-66143 / NIDDK NIH HHS U01-DK-66174 / NIDDK NIH HHS U24 DK082194 / NIDDK NIH HHS U01DK-082194 / NIDDK NIH HHS U24 DK066116 / NIDDK NIH HHS U01 DK066174 / NIDDK NIH HHS
- Language
- English
- Date published
- 07/2020
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Radiation Oncology
- Record Identifier
- 9984070668702771
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