Neurocognitive and functional outcomes at 5 years of age after renal transplant in early childhood
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.
KeywordsRenal transplant Children Development Outcome Neurocognitive
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.Kinney HC, Volpe JJ (2018) Chapter 8 - Myelination events. Volpe’s neurology of the newborn (Sixth Edition): 176–188Google Scholar
- 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. https://doi.org/10.4061/2011/965740
- 14.Weschler D (2002) Weschler preschool and primary scales of intelligence, 3rd edn. Psychological Corporation, San Antonio, TXGoogle Scholar
- 16.Harrison PL, Okland T (2003) Manual of the adaptive behaviour Assessment System II. Psychological Corporation, Harcourt Assessment Company, San Antonio, TXGoogle Scholar
- 17.Cohen J (1988) Statistical power analysis for the behavioral sciences, Second edition. Erlbaum, Hillsdale, NJ [u.a]Google Scholar
- 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