Related Experiment Videos
Evoked potentials in children with chronic renal failure, treated conservatively or by continuous ambulatory
W Hurkx1, I Hulstijn-Dirkmaat, J Pasman
1Department of Pediatrics, University of Nijmegen, The Netherlands.
Insights
Children with chronic renal failure (CRF) experience neurological and developmental issues. Early renal replacement therapy did not show significant differences in neurological development compared to conservative treatment in this study.
Area of Science:
- Pediatric Nephrology
- Neurodevelopmental Pediatrics
- Clinical Neurophysiology
Background:
- Children with chronic renal failure (CRF) often exhibit developmental, intellectual, and motor impairments.
- The potential benefits of early renal replacement therapy (RRT) in mitigating these disturbances remain unclear.
Purpose of the Study:
- To prospectively investigate the neurological and intellectual development of young children (< 5 years) with severe CRF over three years.
- To assess if early RRT influences neurodevelopmental outcomes in pediatric CRF patients.
Main Methods:
- Prospective study over 3 years in 22 children (< 5 years) with CRF (creatinine clearance < 20% of normal).
- Neurological assessment included brainstem auditory evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) recorded every 6 months.
- Comparison between conservative management and continuous ambulatory peritoneal dialysis (CAPD).
Main Results:
- Delayed BAEP peak I suggests peripheral conduction issues, possibly cochlear, but brainstem conduction was normal.
- No significant differences in BAEP or SSEP findings were observed between conservative and CAPD groups.
- Younger children (< 2.5 years) with CRF showed delayed thalamocortical conduction in SSEP, indicating potential delayed myelination.
Conclusions:
- Early RRT (CAPD) did not demonstrate a clear advantage over conservative treatment in improving neurological development in young children with CRF.
- Delayed myelination may be a factor in neurodevelopmental disturbances observed in very young children with CRF.
Abstract:
Children with chronic renal failure (CRF) show developmental, intellectual and motor disturbances. It is questionable if an early start of renal replacement therapy may prevent or delay these disturbances. We studied the neurological and intellectual development of children < 5 years suffering from CRF (creatinine clearance < 20% of normal) prospectively, over a period of 3 years. As part of the neurological study, brainstem auditory evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) were recorded. Measurements were performed in a group of 22 children every 6 months. In 18 of these children CRF was present from birth. Sufficient data were available for analysis in 19 (BAEP) and 22 (SSEP), respectively. A delay of peak I of BAEP gave indications for peripheral conduction disturbances, possibly due to cochlear dysfunction. Brainstem conduction was normal. There were no differences between the children treated conservatively (n = 9) and those treated with continuous ambulatory peritoneal dialysis (CAPD) (n = 10). In children < 2.5 years SSEP showed a delayed thalamocortical conduction, which was not observed in older children. This might indicate a delayed myelination in young children with CRF. No differences were found between the children treated conservatively (n = 10) and those treated with CAPD (n = 12).