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

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An Erratum to this article was published on 09 August 2013

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 <5 years and HD predominated in those 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.

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Authors and Affiliations

  1. Children’s Renal & Urology Unit, Nottingham Children’s Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK

    Alan R. Watson & Wesley N. Hayes

  2. University Hospital Motol, Prague, Czech Republic

    Karel Vondrak

  3. Hopital Cruces, Barakaldo, Vizcaya, Spain

    Gema Ariceta

  4. Centre for Paediatric & Adolescent Medicine, Heidelberg, Germany

    Claus Peter Schmitt

  5. Ankara University Hospital, Ankara, Turkey

    Mesiha Ekim

  6. Hospital Hautepierre, Strasbourg, France

    Michel Fischbach

  7. Pediatrica De Marchi, Fondazione IRCCS Policlinico, Milan, Italy

    Alberto Edefonti

  8. Great Ormond Street Hospital for Children, London, UK

    Rukshana Shroff

  9. Children’s Hospital, University of Helsinki, Helsinki, Finland

    Tuula Holta

  10. Gdansk University Hospital Medical School, Gdansk, Poland

    Aleksandra Zurowska

  11. KfH Paediatric Kidney Centre, Marburg, Germany

    Gunter Klaus

  12. Gazi University Hospital, Ankara, Turkey

    Sevan Bakkaloglu

  13. “A & P Kyriakou”, Children’s Hospital, Athens, Greece

    Constantinos Stefanidos

  14. University Hospital, Ghent, Belgium

    Johan Van de Walle

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  1. Alan R. Watson
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European Paediatric Dialysis Working Group

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Correspondence to Alan R. Watson.

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Watson, A.R., Hayes, W.N., Vondrak, K. et al. Factors influencing choice of renal replacement therapy in European Paediatric Nephrology Units. Pediatr Nephrol 28, 2361–2368 (2013). https://doi.org/10.1007/s00467-013-2555-z

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