A retrospective review of 34 infants who started long-term peritoneal dialysis at </=3 months of age was conducted. Six of the patients died during infancy, leaving 28 infants who survived >1 year and who underwent a formal neurodevelopmental evaluation. In addition to dialysis, treatment of the patients included the use of calcium carbonate as the sole phosphate binder in all patients and supplemental nasogastric tube feeding in 27. At 1 year of age, the 28 patients had a mean head circumference standard deviation score of -0.96+/-1.2. The mental developmental score of 22 (79%) patients fell in the average range, while only 1 (4%) child was significantly delayed. Of 19 children retested at >/=4 years of age, 15 (79%) performed in the average range and 1 (5%) performed in the impaired range. Of 16 patients >/=5 years of age, 15 (94%) attended school full time and in age-appropriate classrooms. Twenty-four patients received their initial kidney transplant at a mean age of 2.1+/-0.8 years. This experience provides evidence that the combination of aggressive nutrition, the elimination of aluminum as a phosphate binder, the provision of dialysis, and subsequent transplantation all contribute to a favorable developmental outcome in infants who develop end-stage renal disease in early infancy.