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Towards guidelines for dialysis in children with end-stage renal disease
1Section of Pediatric Nephrology, Hospital Central de Asturias, Oviedo, Spain. smalaga@correo.uniovi.es
Insights
Spanish pediatric nephrologists developed guidelines for pediatric end-stage renal disease (ESRD) treatment. These flexible guidelines emphasize individualized care and shared decision-making for children requiring renal replacement therapy.
Area of Science:
- Pediatric Nephrology
- Medical Ethics
Background:
- Limited data exist on current treatment selection practices for pediatric end-stage renal disease (ESRD).
- Establishing consensus on renal replacement therapy (RRT) criteria for children is crucial.
Purpose of the Study:
- To establish consensus among Spanish pediatric nephrologists regarding inclusion and exclusion criteria for RRT in children with ESRD.
- To create a starting point for discussion on pediatric ESRD treatment.
Main Methods:
- A survey was distributed to members of the Spanish Pediatric Nephrology Association in 1995.
- Results were analyzed by pediatric nephrologists and bioethicists to compile guidelines.
Main Results:
- A response rate of 43% was achieved.
- Ten guidelines for the treatment of children with ESRD were compiled.
- The guidelines emphasize flexibility and individual case assessment.
Conclusions:
- Proposed guidelines offer a framework for pediatric ESRD treatment decisions.
- Treatment plans should prioritize the patient's best interests.
- Shared decision-making involving parents, professionals, the child, and ethics committees is recommended.
Abstract:
There are few data describing the current practices of treatment selection for children with end-stage renal disease (ESRD). In an effort to establish a consensus among Spanish pediatric nephrologists for inclusion and exclusion criteria for renal replacement therapy in children with ESRD, in 1995 we surveyed members of the Spanish Pediatric Nephrology Association. Although only 43% of members responded, pediatric nephrologists and bioethicists studied the results and compiled a list of ten guidelines for treatment of children with ESRD. The proposed guidelines are meant to be a starting point for further discussion. An emphasis on flexibility, individual case assessment, and consideration of the best interests of the patient must remain central to any treatment plan. Decision making should ideally be shared by parents, professionals, the child, when appropriate, and ethics committees, as necessary.