Impact of Chronic Kidney Disease on Brain Structure and Function in Children

Background: Chronic kidney disease (CKD) in children has a negative impact on several systems including the neurocognitive aspect. The aim of this study was to assess the impact of CKD on brain volume and cognitive development in children, in comparison to those under dialysis, those not under dialysis, and healthy controls. Methods: This case-control research included a total of 33 participants who were divided into three equal groups: Group A (healthy controls, n=11), Group B (CKD patients not on dialysis, n=11), and Group C (CKD patients on dialysis, n=11). Each of the participants took part in a full clinical assessment, lab tests, an IQ test, neurocognitive assessment, and Magnetic resonance imaging (MRI) brain volumetry study. Results: Cognitive testing revealed significant lower IQ as well as Brief international cognitive assessment for multiple sclerosis (BICAMs) scores among CKD children, with the poorest performance in those on dialysis. Strong positive correlations were found between eGFR and IQ, SDMT, CVLT, and BVMT scores (all p < 0.01). An eGFR threshold of ≥11.7 mL/min/1.73 m² best predicted adequate neurocognition (AUC = 0.854) with p=0.001. MRI volumetry demonstrated a selective increase in total white-matter volume in dialysis patients, while other brain structures remained unchanged. Conclusion: This study demonstrates that children with CKD, particularly those on dialysis, exhibit significant hematologic and electrolyte disturbances alongside marked neurocognitive deficits. Structural MRI volumetry revealed a selective increase in total white‑matter volume among dialysis patients, whereas other brain regions remained volumetrically preserved