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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Kinney HC, Volpe JJ (2018) Chapter 8 - Myelination events. Volpe’s neurology of the newborn (Sixth Edition): 176–188

  2. Armstrong F (2006) Neurodevelopment and chronic illness: mechanisms of disease and treatment. Ment Retard Dev Disabil Res Rev 12(3):168–173

    Article  PubMed  Google Scholar 

  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 21:486–491

    Article  CAS  PubMed  Google Scholar 

  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 1:157–165

    Article  CAS  PubMed  Google Scholar 

  5. Ledermann SE, Scanes ME, Fernando ON, Duffy PG, Madden SJ, Trompeter RS (2000) Long-term outcome of peritoneal dialysis in infants. J Pediatr 136:24–29

    Article  CAS  PubMed  Google Scholar 

  6. Lawry KW, Brouhard BH, Cunningham RJ (1994) Cognitive functioning and school performance in children with renal failure. Pediatr Nephrol 8:326–329

    Article  CAS  PubMed  Google Scholar 

  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 4:11–15

    Article  CAS  Google Scholar 

  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 6:53–62

    Article  PubMed  Google Scholar 

  9. Warady BA (2002) Neurodevelopment of infants with end-stage renal disease: is it improving? Pediatr Transplant 6:5–7

    Article  PubMed  Google Scholar 

  10. Warady BA, Belden B, Kohaut E (1999) Neurodevelopmental outcome of children initiating peritoneal dialysis in early infancy. Pediatr Nephrol 13:759–765

    Article  CAS  PubMed  Google Scholar 

  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 89:644–647

    Article  CAS  PubMed  PubMed Central  Google 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

  13. Blishen BR, Carroll WK, Moore C (1987) The 1981 socioeconomic index for occupations in Canada. Can Rev Sociol Anthropol 24:465

    Article  Google Scholar 

  14. Weschler D (2002) Weschler preschool and primary scales of intelligence, 3rd edn. Psychological Corporation, San Antonio, TX

    Google Scholar 

  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. https://doi.org/10.1002/9781118660584.ese0283

    Chapter  Google Scholar 

  16. Harrison PL, Okland T (2003) Manual of the adaptive behaviour Assessment System II. Psychological Corporation, Harcourt Assessment Company, San Antonio, TX

    Google Scholar 

  17. Cohen J (1988) Statistical power analysis for the behavioral sciences, Second edition. Erlbaum, Hillsdale, NJ [u.a]

    Google Scholar 

  18. Johnson RJ, Warady BA (2013) Long-term neurocognitive outcomes of patients with end-stage renal disease during infancy. Pediatr Nephrol 28:283–1291

    Article  Google Scholar 

  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 4:261–267

    Article  CAS  PubMed  Google Scholar 

  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 17:908–912

    Article  PubMed  Google Scholar 

  21. Said G, Boudier L, Selva J, Zingraff J, Drueke T (1983) Different patterns of uremic polyneuropathy clinicopathologic study. Neurology 33:567

    Article  CAS  PubMed  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 8:1429–1448

    Article  PubMed  PubMed Central  Google Scholar 

  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 8:44–51

    Article  PubMed  Google Scholar 

  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 10:177–180

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405 – 87 Ave, Edmonton, AB, T6G 1C9, Canada

    Jillian Popel, Rachel Joffe, Ari R. Joffe, Charlene M. T. Robertson & Catherine J. Morgan

  2. Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada

    Bryan V. Acton

  3. Stollery Children’s Hospital, University of Alberta, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada

    Gwen Y. Bond

  4. Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada

    Julian Midgley

  5. Glenrose Rehabilitation Hospital, 10230 111 Avenue Northwest, Edmonton, AB, T5G 0B7, Canada

    Charlene M. T. Robertson

  6. Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada

    Reg S. Sauve

  7. Department of Pediatrics, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada

    Reg S. Sauve

Authors
  1. Jillian Popel
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  2. Rachel Joffe
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  3. Bryan V. Acton
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  4. Gwen Y. Bond
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  5. Ari R. Joffe
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  6. Julian Midgley
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  7. Charlene M. T. Robertson
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  8. Reg S. Sauve
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  9. Catherine J. Morgan
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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.

Corresponding author

Correspondence to Catherine J. Morgan.

Ethics declarations

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.

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Popel, J., Joffe, R., Acton, B.V. et al. Neurocognitive and functional outcomes at 5 years of age after renal transplant in early childhood. Pediatr Nephrol 34, 889–895 (2019). https://doi.org/10.1007/s00467-018-4158-1

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  • DOI: https://doi.org/10.1007/s00467-018-4158-1

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