Thematic Area: Haemodialysis in Children

Vascular Access in Children Requiring Maintenance Haemodialysis: A Consensus Document by the European Society for Paediatric Nephrology Dialysis Working Group

Reference: Shroff R, Calder F, Bakkaloğlu S, et al. Nephrol Dial Transplant. (2019). doi: 10.1093/ndt/gfz011

British Association for Paediatric Nephrology: Haemodialysis clinical practice guidelines for children and adolescents

Reference: BAPN Haemodialysis Clinical Practice Guidelines 2008

Core Recommendations: 

1. HD for children should take place in specialised paediatric centres able to provide multidisciplinary support.   
2. A transfer process for adolescents must be in place and agreed by referring and receiving units. 
3. Dialysers and lines must be available in neonatal, paediatric and adult sizes.
4. A Kt/V of 1.2 should be the minimum for children and should be checked monthly.
5. Growth and development should be measured regularly as part of the assessment of dialysis adequacy.
6. Dry weight needs regular reassessment in the growing child.
7. A fistula should be considered in children on long-term dialysis; psychological preparation is necessary before fistula creation, and pain during needling prevented
8. Vascular access surgery should be undertaken by appropriately trained and skilled staff.

Comments by Evaluators:

• Guideline rather is a clinical practice recommendation and requires update.
• Document is based on an adult standard document, with specific paediatric adaptations. 
• Evidence search and level of evidence not adequately performed / described (and thus potential clinical consequences remain vague).
• Expert group small (other professions, subspecialties missing).