Transcript SR and consensus study guidelines for children with ESRD

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
Nijmegen
i
12%
Hb too high
50%
Anemia
7%
38%
71%
72%
22%
M0
M12
M24
N=32
N=14
N= 7
Protocol nijmegen
Best Practice BP
Utrecht
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
Best Practice
phosphate
Nijmegen
32%
Too high
Too low
according
to ESPN
58%
43%
29%
57%
71%
10%
M0
M12
M24
N=31
N=14
N=7
• Protocol development
- study group + best practice hospital
- consensus
- applicable in all centres
• Implementation
• Qoc improvement?
Indicators
- PTH
- Calcium
- CAXP
- Lipids
Benchmark iPTH
Based on:
1. KDOQI
>145 pg/ml
<300 pg/mL
Evidence:
Adults: C
(>16 pmol/l) Children: C
(<33 pmol/l)
Too high
Too low
iPTH
Too high
Too low
Best Practice (iPTH )
Amsterdam
HD
PD
• Benchmark: 16-33 pmol/l (145-300)
• 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
11%
12%
Too high
Too low
According to ESPN
Best practice
Liege
HD
PD
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
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