Predictors of academic delay post-pediatric kidney transplant in the USA.

BACKGROUND: Pediatric patients with kidney failure often experience cognitive delays. However, academic delay (being more than one grade level below age-appropriate grade, or in special education) after pediatric kidney transplantation (KTx) has not been explored. We sought to identify patient characteristics associated with a higher risk of academic delay 1 year post-KTx. METHODS: We used the United Network for Organ Sharing (UNOS) database to identify children aged 6-17 years who received a primary KTx between 2014 and 2021 and had a functioning graft 1 year after KTx. The primary outcome was the patient's academic progress at 1 year post-transplant. The secondary outcome was change in academic progress between transplant and 1-year follow-up: onset of new delay, resolution of pre-existing delay, persistence of delay, or no delay at either timepoint. Binomial and multinomial mixed effects logistic regression models were used to predict each outcome based on patient characteristics. RESULTS: The study included 2197 patients, of whom 14% demonstrated academic delay at 1 year post-KTx, 4% demonstrated a new onset of academic delay, 5% demonstrated a resolution of academic delay, and 10% demonstrated persistent academic delay. Patients undergoing transplantation at a younger age, receiving a deceased donor kidney, experiencing longer waitlist times, and undergoing KTx for vascular or other disease indications for KTx were more likely to experience academic delays, including new-onset academic delays. CONCLUSIONS: Academic delays are frequently reported among pediatric KTx recipients. Additional academic support may help resolving or preventing academic delay for at-risk subgroups of children undergoing KTx.

Chronic kidney disease emerging trends in children and what to do about it.

Chronic Kidney disease (CKD) is a major public health problem associated with increased health costs, morbidity, and mortality. There is a 30-fold higher mortality rate and severely impaired quality of life in children with chronic kidney disease (CKD), requiring dialysis or kidney transplant compared to the aged-match general population. The early diagnosis and treatment of pediatric CKD can reverse, delay or prevent progression to advanced kidney disease. It is worth noting that CKD with rapid progression, which carries a poor prognosis, is more common in African American children. Thus, the development of a universal pediatric CKD screening program for high-risk children can be vital for social equity. The disparity in prevalence and severity of CKD is likely due to a complex interaction between biological and nonbiological risk factors that influence the development and progression of CKD in children of African descent. For example, high-risk alleles in the gene encoding for apolipoprotein L1 (APOL1) have been recognized as the most important factor in the high incidence of some chronic kidney diseases in African Americans. In this review, we will focus on the trends in the incidence of pediatric CKD and management strategies aimed at enhancing health outcomes and reducing disease progression.