Bicarbonate, blood pressure, and executive function in pediatric CKD-is there a link?

Background 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. Methods 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. Results Data were available for 865 children. Twenty-two percent had low bicarbonate (CO.sub.2 [less than or equal to] 20 mmol/L) at baseline. On multivariate analysis, there was no relationship between bicarbonate, hypertension, and EF. There was no significant CO.sub.2xhypertension interaction found. A significant interaction (p = 0.01) between high CO.sub.2 ([greater than or equal to] 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.sub.2 groups, higher BPV was associated with better EF in the high CO.sub.2 group. Conclusions 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.
Author(s): Lyndsay A. Harshman [sup.1] , Amy J. Kogon [sup.2] [sup.3] , Matthew B. Matheson [sup.4] , Rebecca J. Johnson [sup.5] , Shlomo Shinnar [sup.6] , Arlene C. Gerson [sup.7] [...]