Consensus procedure for the management of

children with ESRD

Oct 2011

Aim

Defining consensus-based benchmarks

Indicators

- Hemoglobin

- Blood pressure - Phosphate

- PTH - Calcium- CaXP- Lipids

• Implementation

• Benchmark

Best practice Hb

iNijmegen

50%

38%

12%

M0

N=32

M12

N=14

7%

71%

22%

M24

N= 7

72%

Hb too high

Anemia

Protocol nijmegen

Best Practice BPUtrecht

Systolic Diastolic

29%

71%

38%

62% 100%

17%

83%

100%100%

M0 M12 M24

N=24 N=8 N=6

M0 M12 M24

N=24 N=8 N=6

BP> p95

Best Practice phosphate

Nijmegen

32%

58%

10%

43%

57% 71%

29%

M0

N=31

M12

N=14

M24

N=7

Too high

Too low

according to ESPN

• Protocol development

- study group + best practice hospital

- consensus

- applicable in all centres

• Implementation

• Qoc improvement?

Indicators

- PTH

- Calcium

- CAXP

- Lipids

Benchmark iPTH Based on: Evidence:

1. KDOQI

>145 pg/ml (>16 pmol/l)

<300 pg/mL (<33 pmol/l)

Adults: C

Children: C

iPTH Too highToo low

Best Practice (iPTH )

Amsterdam

Too highToo low

HD PD

• Benchmark: 16-33 pmol/l (145-300)

• Target???

Proposal Calcium ? mg/dLBased on: Evidence:

1. KDOQI

mg/dl (mmol/l) 0-5 mo 8,7 -11,3 (2,18-2,83)

6-12mo 8,7- 11,0 (2,18-2,75)

1-5 y 9,4 -10,8 (2,35-2,70)

6-12 y 9,4- 10,3 (2,35-2,58)

13-20y 8,8 –10,2 (2,20-2,55)

Adults: D

Children: D

2. ESPN

mg/dl (mmol/l) “child”: 8.8-10.8 (2.20 - 2.70) “thereafter”: 8.7-10.3 (2.20 - 2.58)

Children: D

Calcium

12%

11%

Too highToo low

According to ESPN

Best practice Liege

HD PD

Proposal CaXP ? mg/dL

Based on: Evidence:

1. KDOQI<12yr:CaXP<65 mg2/dL2 (5.2 mmol2/l2)

>12yr:CaXP<55 mg2/dL2 (4.4 mmol2/l2) Adults: C

Children: D

2. ESPN

CaXP < 60 mg2/dL2 (4.8mmol2/l2) Children: D

3. NfN CaXP<55 mg2/dL2 (4.4 mmol2/l2)

Proposal all lipids

Based on: Evidence:

1. KDOQINormal values (for age and

gender)

Adults: D

Children: D

2. ESPN Only normal values for total

cholesterol and triglycerides

(for age and gender)

None

- Cholesterol ( Total, LDL, HDL) - Triglycerides

LDL cholesterol (<100 mg/dl)

HDL cholesterol (<35mg/dl)

Definitions

• Exit site infection: a minimum of 1 clinical sign of inflammation (redness, warm,pain, pus) with or without positive swab and with antibiotic treatment (not cream or profylactic)

• Rejection: -Biopsy proven rejection with treatment (high dose steroids or antibody treatment) or

- Clinical suspected rejection with rejection treatment

(without biopsy)

To do…

• Tx Infection: Clinical symptoms (fever, GI) and / or parameters (crp, increased creatinin) with a positive culture/PCR/…

• Infection tractus: of clinical symptoms

• X ray: mild/ severe signs of ROD

• Other?

Questions/remarks?

Proposal CRP< ? Mg/L

Based on: Evidence:

1. KDOQI Adults: D

Children: D