The impact of chronic kidney disease on the brain and neurocognitive functioning in children and young adults The INPACT study

The INPACT study investigated the impact of severe chronic kidney disease (CKD) and different treatment modalities (predialysis therapy, dialysis therapy, successful kidney transplantation) in children and young adults on brain structure, brain activity, neurocognitive functioning, and psychosocial outcomes. This was investigated in a sample of 28 patients (aged 9–30 years) and 21 matched healthy controls, using magnetic resonance imaging, electroencephalography, neuropsychological assessment and questionnaires.
Severe CKD was associated with widespread disruption of white matter integrity and altered brain activity, particularly in young patients receiving kidney replacement therapy. Notably, longer time after transplantation was associated with structural brain abnormalities, suggesting that some effects may persist despite restored kidney function. Longer dialysis exposure was linked to slower brain activity (increased delta and decreased alpha power), possibly reflecting early encephalopathy.
Young CKD patients demonstrated lower intelligence and impairments in processing speed, working memory, and alerting attention, especially with more severe disease and longer treatment duration. Brain abnormalities were associated with poorer neurocognitive functioning, indicating that CKD-related changes in the brain contribute to neurocognitive impairments.
Patients also reported lower health-related quality of life (HRQoL) and worse adaptive functioning, particularly those on dialysis. Importantly, the relationship between neurocognitive impairments and lower HRQoL was mediated by worse adaptive functioning, highlighting the clinical relevance of adaptive functioning assessment.
Overall, findings indicate that CKD and its treatment affect the brain, leading to neurocognitive impairments that subsequently impact daily functioning and quality of life. Early identification and targeted interventions are essential to improve long-term outcomes of these patients.