Factors influencing choice of renal replacement therapy in European Paediatric Nephrology Units

Alan R. Watson, Wesley N. Hayes, Karel Vondrak, Gema Ariceta, Claus Peter Schmitt, Mesiha Ekim, Michel Fischbach, Alberto Edefonti, Rukshana Shroff, Tuula Holta, Aleksandra Zurowska, Gunter Klaus, Sevan Bakkaloglu, Constantinos Stefanidos, Johan Van De Walle

Research output: Contribution to journalArticle

Abstract

Background: Many factors may impact upon choice of renal replacement therapy (RRT) for children and adolescents, including patient and family choice, patient size and distance from the renal centre as well as logistic issues such as facilities and staffing at the unit. We report a survey of factors influencing treatment choice in 14 European paediatric nephrology units. Methods: A questionnaire was developed by consensus and completed by 14 members of the European Paediatric Dialysis Working Group on facilities, staffing and family assessments impacting on choice of therapy as well as choice of therapy for 97 patients commencing initial RRT in 2011. Results: All units offered all modalities of RRT, but there were limitations for pre-emptive transplantation (PET) and largely adult surgical dependence for creation of arteriovenous fistulae and transplantation. The average waiting time for a deceased donor kidney was 18.5 (range 3-36) months. Full time dietetic support was available in six of the 14 units. There was no social worker, psychology, play therapy or teaching support in three, two, seven and four units, respectively. Assessment by other members of the multidisciplinary team and home visits before choice of therapy was carried out in 50 % of units, and although all patients were discussed at team meetings, the medical opinion predominated. In terms of types of RRT, 50 % of patients were commenced on chronic peritoneal dialysis (PD), 34 % on haemodialysis (HD) and 16 % underwent pre-emptive transplantation (PET). Chronic PD predominated in patients aged 10 years. Patient and family choice and age or size of patient were predominant factors in choice of therapy with a predictable decline in renal function favouring PET and social factors HD. Conclusions: Chronic peritoneal dialysis predominated as primary choice of RRT, especially in younger children. The PET rates remain low. The influence of surgeons predominanted, and national transplant rules may be significant. Most units had insufficient multiprofessional support, which may impact upon initial choice of therapy as well as sustaining families through RRT.

Original languageEnglish
Pages (from-to)2361-2368
Number of pages8
JournalPediatric Nephrology
Volume28
Issue number12
DOIs
Publication statusPublished - Dec 2013

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Keywords

  • Choice of therapy
  • Dialysis
  • Pediatric
  • Pre-emptive transplantation
  • Psychosocial
  • Renal replacement therapy

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Watson, A. R., Hayes, W. N., Vondrak, K., Ariceta, G., Schmitt, C. P., Ekim, M., Fischbach, M., Edefonti, A., Shroff, R., Holta, T., Zurowska, A., Klaus, G., Bakkaloglu, S., Stefanidos, C., & Van De Walle, J. (2013). Factors influencing choice of renal replacement therapy in European Paediatric Nephrology Units. Pediatric Nephrology, 28(12), 2361-2368. https://doi.org/10.1007/s00467-013-2555-z