consensus procedure for the management of children with esrd oct 2011
TRANSCRIPT
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Consensus procedure for the management of
children with ESRD
Oct 2011
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Aim
Defining consensus-based benchmarks
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Indicators
- Hemoglobin
- Blood pressure - Phosphate
- PTH - Calcium- CaXP- Lipids
• Implementation
• Benchmark
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Best practice Hb
iNijmegen
50%
38%
12%
M0
N=32
M12
N=14
7%
71%
22%
M24
N= 7
72%
Hb too high
Anemia
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Protocol nijmegen
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Best Practice BPUtrecht
Systolic Diastolic
29%
71%
38%
62% 100%
17%
83%
100%100%
M0 M12 M24
N=24 N=8 N=6
M0 M12 M24
N=24 N=8 N=6
BP> p95
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Best Practice phosphate
Nijmegen
32%
58%
10%
43%
57% 71%
29%
M0
N=31
M12
N=14
M24
N=7
Too high
Too low
according to ESPN
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• Protocol development
- study group + best practice hospital
- consensus
- applicable in all centres
• Implementation
• Qoc improvement?
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Indicators
- PTH
- Calcium
- CAXP
- Lipids
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Benchmark iPTH Based on: Evidence:
1. KDOQI
>145 pg/ml (>16 pmol/l)
<300 pg/mL (<33 pmol/l)
Adults: C
Children: C
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iPTH Too highToo low
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Best Practice (iPTH )
Amsterdam
Too highToo low
HD PD
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• Benchmark: 16-33 pmol/l (145-300)
• Target???
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Proposal Calcium ? mg/dLBased on: Evidence:
1. KDOQI
mg/dl (mmol/l) 0-5 mo 8,7 -11,3 (2,18-2,83)
6-12mo 8,7- 11,0 (2,18-2,75)
1-5 y 9,4 -10,8 (2,35-2,70)
6-12 y 9,4- 10,3 (2,35-2,58)
13-20y 8,8 –10,2 (2,20-2,55)
Adults: D
Children: D
2. ESPN
mg/dl (mmol/l) “child”: 8.8-10.8 (2.20 - 2.70) “thereafter”: 8.7-10.3 (2.20 - 2.58)
Children: D
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Calcium
12%
11%
Too highToo low
According to ESPN
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Best practice Liege
HD PD
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Proposal CaXP ? mg/dL
Based on: Evidence:
1. KDOQI<12yr:CaXP<65 mg2/dL2 (5.2 mmol2/l2)
>12yr:CaXP<55 mg2/dL2 (4.4 mmol2/l2) Adults: C
Children: D
2. ESPN
CaXP < 60 mg2/dL2 (4.8mmol2/l2) Children: D
3. NfN CaXP<55 mg2/dL2 (4.4 mmol2/l2)
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Proposal all lipids
Based on: Evidence:
1. KDOQINormal values (for age and
gender)
Adults: D
Children: D
2. ESPN Only normal values for total
cholesterol and triglycerides
(for age and gender)
None
- Cholesterol ( Total, LDL, HDL) - Triglycerides
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LDL cholesterol (<100 mg/dl)
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HDL cholesterol (<35mg/dl)
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Definitions
• Exit site infection: a minimum of 1 clinical sign of inflammation (redness, warm,pain, pus) with or without positive swab and with antibiotic treatment (not cream or profylactic)
• Rejection: -Biopsy proven rejection with treatment (high dose steroids or antibody treatment) or
- Clinical suspected rejection with rejection treatment
(without biopsy)
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To do…
• Tx Infection: Clinical symptoms (fever, GI) and / or parameters (crp, increased creatinin) with a positive culture/PCR/…
• Infection tractus: of clinical symptoms
• X ray: mild/ severe signs of ROD
• Other?
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Questions/remarks?
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Proposal CRP< ? Mg/L
Based on: Evidence:
1. KDOQI Adults: D
Children: D