The cognitive development of pre-school children treated for chronic renal failure.

Chronic renal failure in young children is associated with impaired cognitive development, but recent studies present a more optimistic perspective. An important question is whether the earlier initiation of renal replacement therapy (RRT) might prevent the reported developmental retardation. The cognitive development of 31 patients (age < 5 years with a serum creatinine clearance of < 20% of normal) undergoing different treatment modalities was monitored by repeated measurements during a prospective 3-year study. Fifteen patients received conservative treatment and 16 patients were on dialysis treatment at the start of the project. We were able to evaluate the effect of the onset of RRT on 12 patients who were transferred from conservative treatment to dialysis. At the beginning of the study, the cognitive development of the total group was significantly delayed (mean developmental index = 78.5, SD = 19.5) compared with a normal population. Patients undergoing conservative treatment scored significantly higher (P < 0.01) than those on dialysis. The effect of starting dialysis treatment appeared to be positive, but only a significant short-term improvement was observed. Follow-up evaluation of 7 patients on conservative treatment and of 9 dialysis patients over a 2-year period did not show any significant change in a positive or negative direction. The present study revealed that pre-school dialysis patients are at risk with respect to their cognitive development. This is particularly true for the group with concomitant disorders. Less severe disease in the group on conservative treatment may be assumed to be a positive contributing factor to the more normal performance of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Retarded motor and cognitive development of young children with severe kidney disorders]. / Achterblijvende motorische en cognitieve ontwikkeling van jonge kinderen met een ernstige nieraandoening.

OBJECTIVE: Medical and technical advances make it possible to treat young children with end-stage renal disease with far-reaching methods such as continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis (HD). We investigated whether chronic renal failure has deleterious effects on motor function and cognitive development. SETTING: The pediatric dialysis centres of the university hospitals of Nijmegen, Utrecht and Rotterdam. DESIGN: Prospective study. METHODS: 18 patients (mean age 37 months) with chronic renal failure since infancy and 18 healthy children (mean age 35 months) as controls were assessed on cognitive and behavioural parameters. Nine patients and 17 control subjects were tested on their motor function. RESULTS: A significant delay (more than one SD) was found in the motor as well as in the cognitive development of the patient group. Within this group a large difference was noticed between patients under conservative treatment (n = 8; mean dev. index 92.0) and those under CAPD or HD treatment (n = 10; mean dev. index 72.4). CONCLUSION: Young dialysis patients are evidently at risk for developmental retardation. Monitoring this vulnerable group by developmental screening and intensive counselling of the parents is strongly recommended.