Thematic Area: Haemodialysis in Children
The following guidance document has been adopted based on standardized reviews:
British Association for Paediatric Nephrology:
Haemodialysis clinical practice guidelines for children and adolescents.
- HD for children should take place in specialised paediatric centres able to provide multidisciplinary support.
- A transfer process for adolescents must be in place and agreed by referring and receiving units.
- Dialysers and lines must be available in neonatal, paediatric and adult sizes.
- A Kt/V of 1.2 should be the minimum for children and should be checked monthly.
- Growth and development should be measured regularly as part of the assessment of dialysis adequacy.
- Dry weight needs regular reassessment in the growing child.
- A fistula should be considered in children on long-term dialysis; psychological preparation is necessary before fistula creation, and pain during needling prevented
- 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).