INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Shubert Complex (Posters 1-60) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #49 Decreased Cognitive Efficiency Following Pediatric Kidney Transplantation: A Preliminary Longitudinal Investigation Finola Kane-Grade, University of Minnesota, Minneapolis, United States Danielle Glad, University of Minnesota, Minneapolis, United States Christopher Anzalone, University of Minnesota, Minneapolis, United States Michael Evans, University of Minnesota, Minneapolis, United States Sarah Kizilbash, University of Minnesota, Minneapolis, United States Lidan Gu, University of Minnesota, Minneapolis, United States Category: Medical/Neurological Disorders/Other (Child) Keyword 1: medical disorders/illness Keyword 2: pediatric neuropsychology Keyword 3: cognitive functioning Objective: Children with kidney failure are at increased risk for intellectual functioning, attention, executive functioning, and visual motor integration difficulties (Popel et al., 2019; Shahawy et al., 2020). Neurocognitive findings after kidney transplant are conflicting with some showing continued poor cognitive performance (Qvist et al., 2002; Brouhard et al., 2000) and others showing improved cognitive function (but not fully normalized; Icard et al., 2010; Mendley & Zelko, 1999). Understanding of the neurocognitive outcomes of pediatric kidney failure is largely informed by studies that were published prior to 2010 and is hampered by the lack of neurocognitive data after kidney transplantation. The present study explored the neurocognitive functioning of children with kidney failure before and after kidney transplantation. Participants and Methods: A retrospective chart review was conducted for 25 children and adolescents with kidney failure (11 female; 60% White, 16% Black, 12% Asian, 12% American Indian/Alaskan Native) who underwent a kidney transplant and completed both pre- (Mage=7.04, SD=5.56) and post-transplant (Mage=11.72, SD=5.50) neurocognitive testing at the University of Minnesota. Average age at transplant was 9.30 years (SD=5.32). Cognitive functioning was assessed with standardized measures: Bayley-3, WPPSI-IV, WISC-IV, WISC-V, and WAIS-IV. Univariate analyses examined the relationship between pre- and post-transplant neurocognitive functioning. Relations to race/ethnicity and insurance type (private, public) were also explored. Results: Pre-transplant overall cognitive functioning (M=88.38, SD=16.14) and verbal comprehension (M=87.7, SD=13.9) were significantly lower than the normative mean (p’s=.001). Post-transplant overall cognitive functioning (M=85.5, SD=18.8; p=.001), verbal comprehension (M=91.13, SD=17.9; p=.03), working memory (M=87.8, SD=12.34; p<.001), and processing speed (M=84.4, SD=14.6; p<.001) were all significantly lower than the normative mean. Although pre- to post-transplant performances on all scales were significantly correlated (p's < .05), post-transplant processing speed (t(8)= -2.94, p=.019) and working memory (t(10)= -3.40, p=.007) performances were significantly lower than pre-transplant performances. Stratification by race/ethnicity and insurance type did not yield significant differences (p’s>.05). Conclusions: Reductions in cognitive efficiency (i.e., working memory, processing speed) were evident following transplantation. These findings support previous work that has suggested cognitive function continues to be poor following pediatric kidney transplantation and that attention regulation and additional executive functions can be particularly affected in pediatric kidney failure (Mendley et al., 2015). Executive functions are supported by brain areas that continue to mature into early adulthood (Satterthwaite et al., 2013); thus, it is conceivable that these areas may be vulnerable to the detrimental, multisystem, medical sequelae associated with compromised kidney function. Future research with larger, longitudinal studies that follow cognitive outcomes after kidney transplantation are needed. Understanding of the clinical implications (e.g., predict risk for post-transplantation nonadherence) of these observed cognitive deficits is also warranted.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Shubert Complex (Posters 1-60)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #49

Decreased Cognitive Efficiency Following Pediatric Kidney Transplantation: A Preliminary Longitudinal Investigation

Finola Kane-Grade, University of Minnesota, Minneapolis, United States
Danielle Glad, University of Minnesota, Minneapolis, United States
Christopher Anzalone, University of Minnesota, Minneapolis, United States
Michael Evans, University of Minnesota, Minneapolis, United States
Sarah Kizilbash, University of Minnesota, Minneapolis, United States
Lidan Gu, University of Minnesota, Minneapolis, United States

Category: Medical/Neurological Disorders/Other (Child)

Keyword 1: medical disorders/illness
Keyword 2: pediatric neuropsychology
Keyword 3: cognitive functioning

Objective:

Children with kidney failure are at increased risk for intellectual functioning, attention, executive functioning, and visual motor integration difficulties (Popel et al., 2019; Shahawy et al., 2020). Neurocognitive findings after kidney transplant are conflicting with some showing continued poor cognitive performance (Qvist et al., 2002; Brouhard et al., 2000) and others showing improved cognitive function (but not fully normalized; Icard et al., 2010; Mendley & Zelko, 1999). Understanding of the neurocognitive outcomes of pediatric kidney failure is largely informed by studies that were published prior to 2010 and is hampered by the lack of neurocognitive data after kidney transplantation. The present study explored the neurocognitive functioning of children with kidney failure before and after kidney transplantation.

Participants and Methods:

A retrospective chart review was conducted for 25 children and adolescents with kidney failure (11 female; 60% White, 16% Black, 12% Asian, 12% American Indian/Alaskan Native) who underwent a kidney transplant and completed both pre- (Mage=7.04, SD=5.56) and post-transplant (Mage=11.72, SD=5.50) neurocognitive testing at the University of Minnesota. Average age at transplant was 9.30 years (SD=5.32). Cognitive functioning was assessed with standardized measures: Bayley-3, WPPSI-IV, WISC-IV, WISC-V, and WAIS-IV. Univariate analyses examined the relationship between pre- and post-transplant neurocognitive functioning. Relations to race/ethnicity and insurance type (private, public) were also explored.

Results:

Pre-transplant overall cognitive functioning (M=88.38, SD=16.14) and verbal comprehension (M=87.7, SD=13.9) were significantly lower than the normative mean (p’s=.001). Post-transplant overall cognitive functioning (M=85.5, SD=18.8; p=.001), verbal comprehension (M=91.13, SD=17.9; p=.03), working memory (M=87.8, SD=12.34; p<.001), and processing speed (M=84.4, SD=14.6; p<.001) were all significantly lower than the normative mean. Although pre- to post-transplant performances on all scales were significantly correlated (p's < .05), post-transplant processing speed (t(8)= -2.94, p=.019) and working memory (t(10)= -3.40, p=.007) performances were significantly lower than pre-transplant performances. Stratification by race/ethnicity and insurance type did not yield significant differences (p’s>.05).

Conclusions:

Reductions in cognitive efficiency (i.e., working memory, processing speed) were evident following transplantation. These findings support previous work that has suggested cognitive function continues to be poor following pediatric kidney transplantation and that attention regulation and additional executive functions can be particularly affected in pediatric kidney failure (Mendley et al., 2015). Executive functions are supported by brain areas that continue to mature into early adulthood (Satterthwaite et al., 2013); thus, it is conceivable that these areas may be vulnerable to the detrimental, multisystem, medical sequelae associated with compromised kidney function. Future research with larger, longitudinal studies that follow cognitive outcomes after kidney transplantation are needed. Understanding of the clinical implications (e.g., predict risk for post-transplantation nonadherence) of these observed cognitive deficits is also warranted.