Thematic Area: Dialysis Decision Making

Clinical Practice Recommendations for the Care of Infants with Stage 5 Chronic Kidney Disease

Reference: Zurowska AM, Fischbach M, Watson AR, Edefonti A, Stefanidis CJ; European Paediatric Dialysis Working Group. Pediatr Nephrol. (2013). doi: 10.1007/s00467-012-2300-z

Core Recommendations:

1. Appropriate counselling and shared decision making on treatment options must be discussed with families of infants with antenatally or postnatally diagnosed CKD
2. The timing of initiating RRT in infants with CKD5 needs to be individualised with a major determinant being maintenance of adequate growth, nutrition and development
3. PD is the preferred modality of RRT in infants. 
4. Details on PD catheter placement and care are provided.
5. Use biocompatible fluids to preserve peritoneal membrane function.
6. The dialysis prescription must be adapted for each child taking into account the presence of residual renal function and the child’s growth. Frequent adjustments of the dialysis prescription and medications are necessary to control biochemical abnormalities and fluid status.
7. The most important measure of dialysis adequacy is appropriate growth and development.
8. Nutritional management is an essential part of the management of infants on PD.
9. Psychosocial support and family teaching support are important.
10. Early renal transplantation must remain the goal. 

Comments by Evaluators:

• This document is an expert opinion statement rather than a guideline. Literature in this field is largely descriptive, with no high quality studies, but authors have GRADE-ed all the recommendations as 1B or 1C; thus AGREE criteria are not followed.
• A description of the methods used to formulate the recommendations is lacking.
• The literature review process and development of evidence tables is not described.
• Nurses, dietitians and parent representatives are not included.
• No external review process described.
• Conflict of interest and disclosures of the authors is not described.