Barriers to intensified hemodialysis in pediatric patients
Patients on conventional hemodialysis (HD) face a bleak picture of high morbidity and poor quality of life.
Intensified HD programs, say German, Polish and English nephrologists, could help to improve outcomes – but currently, very few pediatric dialysis centers offer such treatment (Thumfart J et al, Barriers for implementation of intensified hemodialysis: survey results from the International Pediatric Dialysis Network. Pediatr Nephrol 2017, doi: 10.1007/s00467-017-3831-0.). The present study investigating 221 pediatric centers confirms the conundrum: While many pediatric nephrologists consider intensified HD to be the modality that is most likely associated with the best patient outcome (only a small minority favor conventional HD), there is only limited use of the intensified approach.
134 pediatric dialysis centers replied to the survey:
- 69 percent were aware of the evidence in support of the use of intensified HD (independent of whether intensified HD was offered at their own center).
- 50 percent associated the use of daily nocturnal HD with the best overall patient outcome.
- Only two percent of centers stated they were in favor of conventional HD.
- In 38 percent of centers, intensified HD is prescribed to a subgroup of patients, most commonly in the form of short daily HD sessions.
The authors of the present study also inquired about what the centers consider the most important barriers to expansion of intensified HD programs. The reasons given were mainly (and unsurprisingly) a lack of adequate funding (66 %) and a shortage of staff (63 %). Only a few centers report a lack of expertise or motivation (21 % and 14 %, respectively).
A majority of pediatric nephrologists consider an intensified HD as the optimal modality. The fact that its use is still limited underlines the importance of defining and successfully addressing the above-mentioned barriers to implementation, conclude the authors.
Link to the study: https://link.springer.com/article/10.1007%2Fs00467-017-3831-0