Transcript SR and consensus study guidelines for children with ESRD

Consensus procedure
for the management of
children with ESRD
Questions/aims
Aim
Defining consensus-based benchmarks
1. Do we agree with the current guidelines
for the management of ESRD in
children?
2. Are there any gaps?
3. What needs to be improved?
Questions:
•
•
•
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•
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Do we/you know the guideline?
Do we/you agree with it?
What are the limitations?
Do we/you use it?
If so, is this visible in the results?
What needs to be improved?
Indicators
- Hemoglobin
- Blood pressure
- Phosphate
-
PTH (target)
Calcium
CaXP
Dyslipidemia
• Benchmark
Hemoglobin
Lower treshold:
< 2 yr: 10 g/dl or 6.2 mmol/l
> 2 yr: 11 g/dl or 6.8 mmol/l
Upper threshold:
normal value for age
Target: 70%
Hb
12%15%
41%
Hb too high
Anemia
12%
8%
50%
47%
46%
38%
4%
52%
44%
40%
Best practice
i
13%
Hb too high
52%
Anemia
7%
35%
71%
83%
22%
M0
M12
M24
N=31
N=14
N= 6
Blood Pressure
(diastolic and systolic)
< p95 for age, gender and height
According to the Task Force Report 2004
Target: 75%
Blood pressure
38%
38%
62%
38%33%
62% 35%
65%
25%
24%
75% 19%
17%
81% 22%
78%
> p95
Best Practice
Systolic
Diastolic
17%
29%
BP> p95
71%
83%
38%
100%
62%
M0
M12
N=24
N=8
100%
100%
M24
N=6
M0
N=24
M12
M24
N=8
N=6
Phosphate
normal values for age (ESPN)
Based on: ESPN
0-1 yr:1.55 - 2.20 mmol/l (4.8 - 6.8 mg/dl)
1-4 yr:1.29 - 2.20 mmol/l (4.0 - 6.8 mg/dl)
5-11yr:1.19 - 2.10 mmol/l (3.7 - 6.5 mg/dl)
11yr:1.10 - 1.90 mmol/l (3.4 - 5.9 mg/dl)
Target: 60%
Phosphate
25%
Too high
39%
Too low
40%
Too high
Age corrected
Too low
according
to ESPN
53%
30%
38%
55%
8%
7%
36%
48%
39%
13%
Best Practice
phosphate
32%
Too high
Too low
according
to ESPN
58%
43%
17%
57%
83%
10%
M0
M12
M24
N=31
N=14
N=6
Indicators
- PTH
- Calcium
- Dyslipidemia
Target
Benchmarks
Proposal iPTH ? pg/mL
Based on:
1. KDOQI
>145 pg/ml
<300 pg/mL
Evidence:
Adults: C
(>16 pmol/l) Children: C
(<33 pmol/l)
iPTH
24%
Too high
Too low
According to KDOQI
24%
52%
33%
25%
42%
43%
14%
43%
Best Practice (iPTH)
7%
37%
Too high
Too low
14%
56%
43%
43%
M0
N=30
M12
N= 14
25%
50%
25%
M24
N=4
• Target???
Proposal Calcium ? mg/dL
Based on:
1. KDOQI
0-5 mo
6-12mo
1-5 y
6-12 y
13-20y
Evidence:
mg/dl
(mmol/l)
8,7 -11,3
8,7- 11,0
9,4 -10,8
9,4- 10,3
8,8 –10,2
(2,18-2,83)
(2,18-2,75)
(2,35-2,70)
(2,35-2,58)
(2,20-2,55)
2. ESPN
mg/dl
“child”:
8.8-10.8
“thereafter”: 8.7-10.3
Adults: D
Children: D
Children: D
(mmol/l)
(2.20 - 2.70)
(2.20 - 2.58)
Calcium (ESPN)
11%
10%
Too high
Too low
According to ESPN
76%
19%
12%
80%
19%
14%
1%
77%
4%
Best practice
Too high
Too low
According to ESPN
70%
100%
30%
N=10
N=4
Proposal CaXP ? mg/dL
Based on:
Evidence:
1. KDOQI
<12yr:CaXP<65 mg2/dL2
>12yr:CaXP<55 mg2/dL2
(5.2 mmol2/l2)
(4.4 mmol2/l2)
Adults: C
Children: D
2. ESPN
CaXP < 60 mg2/dL2
(4.8mmol2/l2)
3. NfN
CaXP<55 mg2/dL2
(4.4 mmol2/l2)
Children: D
Proposal all lipids
- Cholesterol ( Total, LDL, HDL)
- Triglycerides
Based on:
1. KDOQI
Normal values (for age and
Evidence:
Adults: D
Children: D
gender)
2. ESPN
Only normal values for total
cholesterol and triglycerides
(for age and gender)
None
Total cholesterol
24%
Too high
According to ESPN
13%
17%
)
LDL cholesterol
22%
Too high> 110 mg/dl
16%
19%
HDL cholesterol
Too low< 35 mg/dl
24%
35%
39%
Triglycerides (not after fasting!)
60%
75%
61%
ESPN handbook 2002, after 12 h fasting! Age and gender
corrected
Questions/remarks?
Proposal CRP< ? Mg/L
Based on:
Evidence:
1. KDOQI
Adults: D
Children: D