Abstract

Neurodevelopmental deficits in pediatric and adult survivors of childhood onset chronic kidney disease (CKD) have been documented for many years. This paper reviews the available literature on central nervous system involvement incurred in childhood CKD. The studies reviewed include recent work in neuroimaging, electrophysiology, and neuropsychology, along with commentary on school functioning and long-term outcomes. The paper concludes with suggestions for monitoring the neurodevelopmental status and pursuing appropriate early interventions for children with CKD.

Highlights

  • Neurodevelopmental deficits in pediatric and adult survivors of childhood onset chronic kidney disease (CKD) have been documented for many years

  • This review describes the current understanding of the nervous system structure and function in children with CKD and highlight areas where additional study is needed

  • Hulstijn-Dirkmaat et al [24] compared the general development of toddlers with chronic renal insufficiency (CRI) receiving conservative therapy with dialysis-dependent children. These investigators found that the children with CRI had a significantly better developmental index as a group when compared with the dialysis-dependent children, with the dialysis-dependent children manifesting a mean developmental index that fell

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Summary

Neurodevelopmental outcomes in children with CKD

In addition to the assessment of CNS structure and nerve conduction, the functional status of the developing child is assessed though neuropsychological testing and educational achievement. Cross-sectional studies of children with CKD suggested that there is increased risk for delays in neurocognitive development, for toddlers [17,18,19] and children with end-stage renal disease (ESRD) [17,18,19,20,21,22,23]. No large-scale, prospective neurocognitive evaluation of this health-challenged group has been done to allow for an accurate prediction of the incidence, prevalence, and magnitude of developmental problems. The studies to date have used modestly sized cohorts to examine general neurocognitive functions as well as more specific neurocognitive domains, including attention, executive

General neurocognitive function
Academic achievement
Specific neurocognitive functions
Academic achievement and school functioning
Assessment and management
Findings
Conclusion
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