Cognitive Function in Children with Lupus Nephritis: A Cross-Sectional Comparison with Children with Other Glomerular Chronic Kidney Diseases

Abstract

Objective: To identify factors contributing to cognitive impairment in children with lupus nephritis.

Study design: A cross-sectional analysis of a large multicenter national cohort of children with chronic kidney disease (CKD) using standardized measures to determine baseline neuropsychiatric function and health-related quality of life (HRQoL) in children with lupus nephritis (n = 34), and to compare baseline function with that in children with other forms of glomerular CKD (gCKD; n = 171). We used inverse probability weighting via a logistic model for propensity score analysis to achieve balance between children with lupus nephritis and those with other glomerular causes of CKD, adjusting for known confounders. We used linear regression models to compare neurocognitive outcomes between exposure groups, adjusting for current prednisone use and testing for an interaction between current prednisone use and lupus nephritis, and to test for an association between cognitive function and HRQoL.

Results: Current prednisone use was independently associated with worse attention (P < .01) and better adaptive skills (P = .04), and there was a significant interaction between current prednisone use and lupus nephritis for internalizing problems, with worse parent-reported internalizing problems in children with lupus nephritis on prednisone (P = .047). Better parent-reported HRQoL was associated with better visual memory (P = .01), and better child-reported HRQoL was associated with better attention (P < .01) and inhibitory control (P < .01). Both parent and child HRQoL were associated with better measures of executive function (P = .02 and < .001, respectively).

Conclusion: Children with lupus nephritis have comparable or better cognitive function than their peers with other gCKDs, which is reassuring given the multiorgan and lifelong complications associated with lupus.

Keywords: Health-related quality of life; adolescents; chronic kidney disease; glomerulonephritis; pediatric; psychosocial.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2017 Elsevier Inc. All rights reserved.

Figures

Figure

Association of HRQoL with neurocognitive and behavioral outcomes among children with gCKD. The effect of HRQoL is shown in SDs of T-scores for neurocognitive and behavioral outcomes. Linear regression models were adjusted for eGFR, urine protein/creatinine ratio, systolic blood pressure Z-score, and maternal education. An interaction between lupus nephritis and HRQoL was significant only in the model for the effect of Parent Overall HRQoL on the Global Executive Composite.