[A survey on the inclusion criteria in pediatric dialysis and transplantation programs in terminal renal failure]

The purpose of this study was to know the current practices of Spanish pediatric nephrologists concerning the inclusion or not of children with end-stage renal disease (ESRD) in programs of dialysis and transplantation in order to open a discussion on the topic that would allow a consensus to be reached.

A descriptive and prospective study using an anonymously mailed survey to 90 members of the Spanish Pediatric Nephrology Association was carried out.

The index of response was 43%. In 90% of the physicians polled they believe that some situations exist where it is advisable not to include a child with ERF in dialysis and, although all assure that there are no written procedures, a large majority (85%) think that they should exist, at least in the most representative cases. Serious physical and/or intellectual handicap and poor prognosis constitute the most important factors for making a decision. The expressed desire of the parents is considered the third most important factor by 56%. Of the answers, 82% placed economic cost of the substituting treatments as least important. Ninety-two percent think that not always and not in all cases is it necessary to turn to all possible technical means to extend the life. More than half (54%) think that the last decision must be taken by the physician and the family, although 44% confer this power to the Ethical Committee.

It would be useful to develop guidelines to help pediatric nephrologists and/or ethical committees to decide, with the family of the patient, about the inclusion of the child in ESRD in programs of dialysis and transplantation.