ESPN 50th Annual Meeting

ESPN 2017


 
Financial barriers prevent implementation of intensified hemodialysis - Survey analysis of the International Pediatric Dialysis Network -
JULIA THUMFART 1 STEFFEN WAGNER 2 FRANZ SCHAEFER 3 BRADLEY WARADY 4 DOMINIK MÜLLER 1 CLAUS PETER SCHMITT 3

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY CHARITé BERLIN, GERMANY
2- INWT STATISTICS GMBH BERLIN, GERMANY
3- DEPARTMENT OF PEDIATRIC NEPHROLOGY, UNIVERSITY HOSPITAL FOR PEDIATRIC AND ADOLESCENT MEDICINE, HEIDELBERG, GERMANY
4- DIVISION OF PEDIATRIC NEPHROLOGY, CHILDREN’S MERCY HOSPITAL, KANSAS CITY, MISSOURI
 
Introduction:

In pediatric patients on conventional hemodialysis (HD), morbidity is high and quality of life is poor. To overcome these shortcomings of conventional dialysis, intensified HD programs have been developed. The feasibility and outcome in children have been reported from few pediatric dialysis centers only.

Material and methods:

An online survey was carried out in all 221 pediatric dialysis centers participating in the International Pediatric Dialysis Network (IPDN) to assess, the attitude of pediatric nephrologists towards intensified HD, penetrance into clinical practice and respective barriers.

 

Results:

134 (61%) of the centers replied to the questionnaire. 69% of the pediatric nephrologists recognize sufficient evidence in favor of intensified HD independent from the fact whether they offer intensified HD or not. 50% consider daily nocturnal HD, 21% short daily and 10% intermittent nocturnal HD to offer the best overall patient outcome. Only 2% consider conventional HD to provide the best patient outcome. 80% work in centers where new ideas are greeted, and institutional barriers are few. 57% of pediatric nephrologists always try to convince patients and care givers to apply the best available dialysis modality. 38% of the respondent pediatric nephrologists realize intensified HD in a subgroup of patients, mainly short daily HD. 36% of these centers offer home HD. The most important organizational barriers to expand intensified HD programs were lack of adequate funding (66%) and lack of stuff (63%), whereas lack of expertise (21%) and of motivation (14%) were reported infrequently.

 

Conclusions:

The majority of nephrologists consider intensified HD as the best HD treatment for children, but a minority only applies it to some of their patients. Inappropriate funding represents the most important barrier for implementation of intensified HD into clinical practice.