Neurocognitive and functional outcomes at 5 years of age after renal transplant in early childhood

  • Jillian Popel
  • Rachel Joffe
  • Bryan V. Acton
  • Gwen Y. Bond
  • Ari R. Joffe
  • Julian Midgley
  • Charlene M. T. Robertson
  • Reg S. Sauve
  • Catherine J. MorganEmail author
Original Article



Clinicians often use information about developmental outcomes in decision-making around offering complex, life-saving interventions in children such as dialysis and renal transplant. This information in children with end-stage renal disease (ESRD) is limited, particularly when ESRD onset is in infancy or early childhood.


Using data from an ongoing prospective, longitudinal, inception cohort study of children with renal transplant before 5 years of age, we evaluated (1) the risk of adverse neurocognitive and functional outcomes at 5 years of age and (2) predictors of developmental outcomes.


We found evidence of neurocognitive sequelae of ESRD in very young children; however, developmental outcomes appear remarkably better when compared with findings of two or three decades ago. Less time on dialysis predicted higher developmental scores, and hemodialysis was associated with poorer developmental outcomes.


Our data suggest that renal replacement therapies in young children are associated with acceptable developmental outcome. Programs to identify those with developmental delays and provide early intervention may allow achievement of the child’s full potential.


Renal transplant Children Development Outcome Neurocognitive 


Author contributions

All authors made substantial contribution to the study and paper: C. Morgan, J. Popel, C. Robertson, and G. Bond—research design, data acquisition, data analysis, and interpretation of results; J. Popel, R. Joffe, and C. Morgan—data acquisition and drafting the paper; J. Midgley and R. Sauve—data acquisition; A. Joffe and B. Acton—interpretation of results. All authors have revised the paper critically and approved the final version for submission.

Compliance with ethical standards

The project was approved by local health research ethics boards. All parents/guardians provided informed consent for follow-up and participation in the program.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kinney HC, Volpe JJ (2018) Chapter 8 - Myelination events. Volpe’s neurology of the newborn (Sixth Edition): 176–188Google Scholar
  2. 2.
    Armstrong F (2006) Neurodevelopment and chronic illness: mechanisms of disease and treatment. Ment Retard Dev Disabil Res Rev 12(3):168–173CrossRefGoogle Scholar
  3. 3.
    Rotundo A, Nevins TE, Lipton M, Lockman LA, Mauer SM, Michael AF (1982) Progressive encephalopathy in children with chronic renal insufficiency in infancy. Kidney Int 21:486–491CrossRefGoogle Scholar
  4. 4.
    Polinsky MS, Kaiser BA, Stover JB, Frankenfield M, Baluarte HJ (1987) Neurologic development of children with severe chronic renal failure from infancy. Pediatr Nephrol 1:157–165CrossRefGoogle Scholar
  5. 5.
    Ledermann SE, Scanes ME, Fernando ON, Duffy PG, Madden SJ, Trompeter RS (2000) Long-term outcome of peritoneal dialysis in infants. J Pediatr 136:24–29CrossRefGoogle Scholar
  6. 6.
    Lawry KW, Brouhard BH, Cunningham RJ (1994) Cognitive functioning and school performance in children with renal failure. Pediatr Nephrol 8:326–329CrossRefGoogle Scholar
  7. 7.
    Fennell R, Fennell E, Carter R, Mings E, Klausner A, Hurst J (1990) A longitudinal study of the cognitive function of children with renal failure. Pediatr Nephro 4:11–15CrossRefGoogle Scholar
  8. 8.
    Qvist E, Pihko H, Fagerudd P, Valanne L, Lamminranta S, Karikoski J, Sainio K, Rönnholm K, Jalanko H, Holmberg C (2002) Neurodevelopmental outcome in high-risk patients after renal transplantation in early childhood. Pediatr Transplant 6:53–62CrossRefGoogle Scholar
  9. 9.
    Warady BA (2002) Neurodevelopment of infants with end-stage renal disease: is it improving? Pediatr Transplant 6:5–7CrossRefGoogle Scholar
  10. 10.
    Warady BA, Belden B, Kohaut E (1999) Neurodevelopmental outcome of children initiating peritoneal dialysis in early infancy. Pediatr Nephrol 13:759–765CrossRefGoogle Scholar
  11. 11.
    Bawden HN, Acott P, Carter J, Lirenman D, MacDonald GW, McAllister M, McDonnell MC, Shea S, Crocker J (2004) Neuropsychological functioning in end-stage renal disease. Arch Dis Child 89:644–647CrossRefGoogle Scholar
  12. 12.
    Robertson CM, Sauve RS, Joffe AR, Alton GY, Moddemann DM, Blakley PM, Synnes AR, Dinu IA, Harder JR, Soni R, Bodani JP, Kakadekar AP, Dyck JD, Human DG, Ross DB, Rebeyka IM (2011) The registry and follow-up of complex pediatric therapies program of western Canada: a mechanism for service, audit, and research after life-saving therapies for young children. Cardiol Res Pract 965740.
  13. 13.
    Blishen BR, Carroll WK, Moore C (1987) The 1981 socioeconomic index for occupations in Canada. Can Rev Sociol Anthropol 24:465CrossRefGoogle Scholar
  14. 14.
    Weschler D (2002) Weschler preschool and primary scales of intelligence, 3rd edn. Psychological Corporation, San Antonio, TXGoogle Scholar
  15. 15.
    Viezel K, Zibulsky J, Dumont R, Willis JO (2014) Beery-Buktenica developmental test of visual-motor integration, sixth edition. In: Reynolds CR, Vannest KJ, Fletcher-Janzen E (eds) Encyclopedia of special education. CrossRefGoogle Scholar
  16. 16.
    Harrison PL, Okland T (2003) Manual of the adaptive behaviour Assessment System II. Psychological Corporation, Harcourt Assessment Company, San Antonio, TXGoogle Scholar
  17. 17.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, Second edition. Erlbaum, Hillsdale, NJ [u.a]Google Scholar
  18. 18.
    Johnson RJ, Warady BA (2013) Long-term neurocognitive outcomes of patients with end-stage renal disease during infancy. Pediatr Nephrol 28:283–1291CrossRefGoogle Scholar
  19. 19.
    Brouhard BH, Donaldson LA, Lawry KW, McGowan KR, Drotar D, Davis I, Rose S, Cohn RA, Tejani A (2000) Cognitive functioning in children on dialysis and post-transplantation. Pediatr Transplant 4:261–267CrossRefGoogle Scholar
  20. 20.
    Crocker JF, Acott PD, Carter JE, Lirenman DS, MacDonald GW, McAllister M, McDonnell MC, Shea S, Bawden HN (2002) Neuropsychological outcome in children with acquired or congenital renal disease. Pediatr Nephrol 17:908–912CrossRefGoogle Scholar
  21. 21.
    Said G, Boudier L, Selva J, Zingraff J, Drueke T (1983) Different patterns of uremic polyneuropathy clinicopathologic study. Neurology 33:567CrossRefGoogle Scholar
  22. 22.
    Moodalbail DG, Reiser KA, Detre JA, Schultz RT, Herrington JD, Davatzikos C, Doshi JJ, Erus G, Liu HS, Radcliffe J, Furth SL, Hooper SR (2013) Systematic review of structural and functional neuroimaging findings in children and adults with CKD. Clin J Am Soc Nephrol 8:1429–1448CrossRefGoogle Scholar
  23. 23.
    Valanne L, Qvist E, Jalanko H, Holmberg C, Pihko H (2004) Neuroradiologic findings in children with renal transplantation under 5 years of age. Pediatr Transplant 8:44–51CrossRefGoogle Scholar
  24. 24.
    Orofino L, Marcen R, Quereda C, Villafruela JJ, Sabater J, Matesanz R, Pascual J, Ortuno J (1990) Epidemiology of symptomatic hypotension in hemodialysis: is cool dialysate beneficial for all patients? Am J Nephrol 10:177–180CrossRefGoogle Scholar

Copyright information

© IPNA 2018

Authors and Affiliations

  • Jillian Popel
    • 1
  • Rachel Joffe
    • 1
  • Bryan V. Acton
    • 2
  • Gwen Y. Bond
    • 3
  • Ari R. Joffe
    • 1
  • Julian Midgley
    • 4
  • Charlene M. T. Robertson
    • 5
    • 1
  • Reg S. Sauve
    • 6
    • 7
  • Catherine J. Morgan
    • 1
    Email author
  1. 1.Department of Pediatrics, Edmonton Clinic Health AcademyUniversity of AlbertaEdmontonCanada
  2. 2.Royal University HospitalUniversity of SaskatchewanSaskatoonCanada
  3. 3.Stollery Children’s HospitalUniversity of AlbertaEdmontonCanada
  4. 4.Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
  5. 5.Glenrose Rehabilitation HospitalEdmontonCanada
  6. 6.Alberta Children’s HospitalCalgaryCanada
  7. 7.Department of PediatricsUniversity of CalgaryCalgaryCanada

Personalised recommendations