63 - Impact of pediatric chronic kidney disease on long-term educational attainment and employment

Poster Number: 63
Publication Number: 63.341

Lyndsay Harshman, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Ryan C. Ward, University of Iowa Roy J. and Lucille A. Carver College of Medicine, TIFFIN, IA, United States; Matthew Matheson, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Rebecca J. Johnson, Children's Mercy Kansas City, Kansas City, MO, United States; BRADLEY A. WARADY, CHILDREN'S MERCY KANSAS CITY, KANSAS CITY, MO, United States; Susan Furth, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Stephen R. Hooper, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

Background: Children with pediatric chronic kidney disease (CKD) are at risk for academic underachievement and neurocognitive deficits. This population may be at risk for lower educational attainment and difficulty obtaining/maintaining employment; however, large-scale data from contemporary cohorts are lacking. Furthermore, historical education and employment data exist in isolation from neurocognitive assessment and evaluation of kidney function.

Objective: We utilized data from the Chronic Kidney Disease in Children (CKiD) prospective cohort study to characterize highest educational attainment and employment status in young adults with CKD. Secondarily, we utilized ratings of executive function as a predictor of future educational attainment and employment status.

Design/Methods: This study used phone-in-person (PIP) data from the CKiD study. Inclusion required at least one PIP at or after 18 years age, participation in a CKiD cognitive evaluation between ages 10-16 years, and assessment of kidney function at the time of cognitive evaluation. Patient-report data from the most recent PIP described educational and employment outcomes. Highest grade completed was predicted using linear regression models that included parent-reported executive function and kidney-specific data from the time of cognitive assessment. Covariates included 1) participant age and socioeconomic status at cognitive assessment and 2) renal replacement therapy status at the time of PIP completion.

Results: Employment and educational data were available for 180 CKiD participants aged > 18 years. By age 22 (N = 100), 8% had not completed high school, 52% had completed high school but no college, and 40% had completed at least two years of college. In context, the 52% rate for high school graduation was much lower than the national average of 86%. Among the full sample (N = 180), 60% were part- or full-time employed, 15% were non-working students, and 25% were unemployed and/or receiving disability. After adjusting for covariates, better ratings (lower score) on the Behavior Rating Inventory of Executive Function Global Executive Composite between age 10-16 years predicted grade level completed among participants aged 22 and older (Table 1). Conclusion(s): Pediatric CKD is a risk factor for both lower educational attainment and employment. Executive functioning in early adolescence predicts terminal grade level completion. Interventions to aid pediatric CKD patients in school and strategies to facilitate executive functioning should be implemented to avoid missed educational and career opportunities.
Table 1Prediction of highest level of grade completion for subjects aged 22 and older. Performance on the Behavior Rating Inventory of Executive Function Global Executive Composite between 10-16 years of age predicts highest grade completed.