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Neurodevelopmental outcome of children initiating peritoneal dialysis in early infancy
B A Warady1, B Belden, E Kohaut
1Department of Pediatrics, The Children's Mercy Hospital, 2401 Gillham Road, Kansas City, Missouri 64108, USA.
Insights
Infants with end-stage renal disease receiving peritoneal dialysis, aggressive nutrition, and early kidney transplants show favorable neurodevelopmental outcomes. This approach supports cognitive and physical development in young children with kidney failure.
Area of Science:
- Pediatric Nephrology
- Developmental Pediatrics
Background:
- Infants with end-stage renal disease (ESRD) face significant developmental challenges.
- Early intervention is crucial for improving long-term outcomes in these vulnerable patients.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes of infants with ESRD treated with long-term peritoneal dialysis and other supportive therapies.
- To identify key factors contributing to favorable development in infants with early-onset kidney disease.
Main Methods:
- Retrospective review of 34 infants (<3 months old) undergoing long-term peritoneal dialysis.
- Neurodevelopmental evaluations at 1 year, and follow-up assessments at 4 and 5 years of age.
- Analysis of treatment modalities including phosphate binders (calcium carbonate) and nutritional support (nasogastric tube feeding).
Main Results:
- 28 infants survived >1 year and underwent neurodevelopmental evaluation.
- At 1 year, mean head circumference SDS was -0.96±1.2; 79% had average mental developmental scores.
- At 4 years, 79% performed in the average range; by 5 years, 94% attended age-appropriate school.
- 24 patients received kidney transplants at a mean age of 2.1±0.8 years.
Conclusions:
- A combination of aggressive nutrition, phosphate management (avoiding aluminum), peritoneal dialysis, and early kidney transplantation leads to favorable neurodevelopmental outcomes in infants with ESRD.
- This multidisciplinary approach supports successful integration into age-appropriate schooling and overall development.
Abstract:
A retrospective review of 34 infants who started long-term peritoneal dialysis at 1 year and who underwent a formal neurodevelopmental evaluation. In addition to dialysis, treatment of the patients included the use of calcium carbonate as the sole phosphate binder in all patients and supplemental nasogastric tube feeding in 27. At 1 year of age, the 28 patients had a mean head circumference standard deviation score of -0.96+/-1.2. The mental developmental score of 22 (79%) patients fell in the average range, while only 1 (4%) child was significantly delayed. Of 19 children retested at >/=4 years of age, 15 (79%) performed in the average range and 1 (5%) performed in the impaired range. Of 16 patients >/=5 years of age, 15 (94%) attended school full time and in age-appropriate classrooms. Twenty-four patients received their initial kidney transplant at a mean age of 2.1+/-0.8 years. This experience provides evidence that the combination of aggressive nutrition, the elimination of aluminum as a phosphate binder, the provision of dialysis, and subsequent transplantation all contribute to a favorable developmental outcome in infants who develop end-stage renal disease in early infancy.