title: Early kidney transplantation improves neurocognitive outcome in patients with severe congenital chronic kidney disease.
abstract: Renal replacement therapy has become available for the majority of patients suffering from severe congenital chronic kidney disease (CKD). Data on the long-term neurocognitive outcome and the impact of early kidney transplantation (KTx) in this setting is unclear. Neurocognitive outcomes in 15 patients (11 male) with isolated congenital CKD (stage 3-5) requiring KTx at a mean age of 2.8 ± 1.3 were assessed at a mean age of 8.3 ± 1.4 years. Patients underwent neurological examination and testing for neuromotor and neurocognitive function using three independent tests. Pre-emptive KTx was performed in six patients, and nine patients were dialyzed prior to KTx for a mean period of 11.1 ± 8.6 months. Neuromotor function was abnormal in 8/15 patients. HAWIK-III showed a global intelligence quotient (IQ) of 93.5 ± 11.4 (P = 0.05) due to a significantly reduced performance IQ of 89.1 ± 11.3 (P < 0.01). In three patients, the global IQ was clinically significantly reduced by >1 SD to <85. In patients with neuromotor dysfunction, performance IQ was lower than in patients with normal neuromotor function (83.8 ± 10.2 vs. 96.2 ± 9.0, P = 0.04). Time on dialysis was inversely correlated to verbal IQ (r = 0.78, P = 0.02). Pre-emptive KTx and duration of dialysis treatment <3 months was associated with superior neurocognitive outcome. Early (pre-emptive) KTx results in superior long-term neurocognitive outcome in children with severe congenital CKD.
authors.affiliation: Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Hartmann
authors.forename: Nicola
authors.initials: N
authors.lastname: Hawellek
authors.forename: Mirja
authors.initials: M
authors.lastname: Wedekin
authors.forename: Charlotte
authors.initials: C
authors.lastname: Vogel
authors.forename: Anibh M
authors.initials: AM
authors.lastname: Das
authors.forename: Katharina
authors.initials: K
authors.lastname: Balonwu
authors.forename: Jochen H H
authors.initials: JH
authors.lastname: Ehrich
authors.forename: Dieter
authors.initials: D
authors.lastname: Haffner
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
mesh_terms: D002648:Child; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D011594:Psychometrics; D051436:Renal Insufficiency, Chronic / Q000151:congenital* / Q000523:psychology* / Q000601:surgery; D012189:Retrospective Studies
keywords: chronic kidney disease; dialysis; infant; kidney transplantation; outcome