Background: Neurofilament light chain (NfL) protein is a blood-based marker of neuroaxonal injury. We sought to 1) compare plasma NfL levels in children with chronic kidney disease (CKD) and healthy peers, 2) characterize the relationship between NfL level and kidney function, and 3) evaluate NfL as a predictor of abnormal brain structure in CKD. Methods: Sixteen children with CKD due to congenital kidney anomalies and 23 typically developing peers were included. Plasma NfL was quantified using single-molecule array immunoassay. Participants underwent structural magnetic resonance imaging. Multiple linear regression models were used to evaluate the association between plasma NfL levels, kidney function, and brain structure. Results: An age × group interaction was identified whereby NfL levels increased with age in the CKD group only (estimate = 0.65; CI = 0.08–1.22; p = 0.026). Decreased kidney function was associated with higher NfL levels (estimate = −0.10; CI = −0.16 to −0.04; p = 0.003). Lower cerebellar gray matter volume predicted increased plasma NfL levels (estimate = −0.00024; CI = −0.00039–0.00009; p = 0.004) within the CKD group. Conclusion: Children with CKD show accelerated age-related increase in NfL levels. NfL level is associated with lower kidney function and abnormal brain structure in CKD.
Background Pediatric chronic kidney disease (CKD) patients are at risk for cognitive deficits with worsening disease progression. Limited, existing cross‐sectional studies suggest that cognitive deficits may improve following kidney transplantation. We sought to assess cognitive performance in relationship to kidney transplantation and kidney‐specific medical variables in a sample of pediatric kidney transplant patients who provided cross‐sectional and longitudinal observations. Methods A retrospective chart review was conducted in patients who completed pre‐ and/or post‐transplant neurocognitive testing at the University of Iowa from 2015–2021. Cognitive outcomes were investigated with developmentally appropriate, standardized measures. Mixed linear models estimated the impact of transplant status on cognitive function (z‐scores). Subsequent post‐hoc t‐tests on change scores were limited to patients who had provided pre‐ and post‐transplant assessments. Results Thirty eight patients underwent cognitive assessments: 10 had both pre‐ and post‐transplant cognitive assessments, 11 had pre‐transplant assessments only, and 17 had post‐transplant data only. Post‐transplant status was associated with significantly lower full‐scale IQ and slower processing speed compared to pre‐transplant status (estimate = −0.32, 95% confidence interval [CI] = −0.52: −0.12; estimate = −0.86, CI = −1.17: −0.55, respectively). Post‐hoc analyses confirmed results from the mixed models (FSIQ change score = −0.34, 95% CI = −0.56: −0.12; processing speed change score = −0.98, CI = −1.28: −0.68). Finally, being ≥80 months old at transplant was associated with substantially lower FSIQ compared to being <80 months (estimate = −1.25, 95% CI = −1.94: −0.56). Conclusions Our results highlight the importance of monitoring cognitive function following pediatric kidney transplant and identify older transplant age as a risk factor for cognitive deficits.
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