Related Experiment Video
Updated: May 31, 2025
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Survey of legislative frameworks and national recommendations governing paediatric maintenance haemodialysis in
Enzo Vedrine1, Claus Peter Schmitt2, Johan Vande Walle3
1Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France.
Insights
National laws and recommendations for pediatric maintenance hemodialysis (HD) are scarce and inconsistent across Europe. This variability highlights the need for improved guidelines to ensure safe and effective pediatric HD practices.
Area of Science:
- Pediatric Nephrology
- Healthcare Policy
- Dialysis Management
Background:
- International recommendations for pediatric maintenance hemodialysis (HD) require reinforcement through national legislation or guidelines.
- Significant variation exists in current national regulations across European countries.
Purpose of the Study:
- To survey and describe the existing national rules governing pediatric maintenance HD in European nations.
- To identify gaps in legal or recommended frameworks for pediatric HD.
Main Methods:
- A cross-sectional survey was conducted across 42 European countries.
- National representatives from pediatric nephrology societies completed online questionnaires.
- Data were collected on national laws and recommendations for pediatric HD.
Main Results:
- Responses were obtained from 36 countries, revealing wide variations in population served and patient numbers per center.
- Specific regulations regarding the minimum age for dialysis in adult centers, pediatrician presence, staffing ratios, and ancillary support staff (dietitians, psychologists) were found in a minority of countries.
- The existence and specifics of laws or recommendations varied significantly, with only 8% of countries mandating nurse-to-patient ratios.
Conclusions:
- Laws and written recommendations for pediatric maintenance HD are infrequently established and highly inconsistent among European countries.
- There is a clear need for dialogue among pediatric nephrologists, adult nephrologists, and health authorities to standardize and enhance the organization of pediatric HD.
- Developing unified guidelines is crucial for ensuring safe and effective pediatric hemodialysis practices across Europe.
Background:
The application of international recommendations for paediatric maintenance haemodialysis (HD) could be strengthened by national laws or written recommendations. Our aim was therefore to describe the national rules governing paediatric maintenance HD in European countries.
Methods:
A national representative, approved by the president of each paediatric nephrology society, was contacted in all 42 European countries to complete two online questionnaires.
Results:
Answers were received from 36 countries. The population served by HD centres varies from 83,000 to 1,197,000 residents below 18 years of age and the estimated mean number of children on HD per centre from 0.2 to 13.5. The lowest age at which a child can be dialysed in an adult centre varies from 0 to 18 years. Laws or written national recommendations specifying: this age, the need for a paediatrician as part of medical team in mixed adult-paediatric centres, the minimum number of doctors per centre and the number of patients per nurse or nurse's aide required during sessions exist in only 25, 22, 22, 44 and 8% of the countries, respectively. Similarly, dietitians, social workers, school service, psychologists and play specialists/youth workers are required by law or written national recommendations in 36, 28, 36, 31 and 14% of countries, respectively.
Conclusion:
Laws or written national recommendations for paediatric maintenance HD are rare in European countries and very heterogeneous when they exist. This calls for discussion among paediatric and adult nephrologists and health authorities on the organisation of safe and effective paediatric HD practices.
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:19Standards of Care II
01:22Standards of Care I
01:33Hormonal Regulation
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...