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Consensus procedure for the management of children with ESRD

Consensus procedure for the management of children with ESRD. Oct 2011. Aim. Defining consensus-based benchmarks. Hemoglobin Blood pressure Phosphate PTH Calcium CaXP Lipids. Implementation Benchmark. Indicators. Best practice Hb. Nijmegen. i. 12%. Hb too high Anemia.

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Consensus procedure for the management of children with ESRD

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  1. Consensus procedure for the management of children withESRD Oct 2011

  2. Aim Defining consensus-based benchmarks

  3. Hemoglobin Blood pressure Phosphate PTH Calcium CaXP Lipids Implementation Benchmark Indicators

  4. Best practice Hb Nijmegen i 12% Hb too high Anemia 50% 7% 71% 38% 72% 22% M0 N=32 M12 N=14 M24 N= 7

  5. Protocol nijmegen

  6. Best Practice BP Utrecht Systolic Diastolic 17% 29% BP> p95 71% 83% 38% 100% 62% 100% 100% M0 M12 M24 N=24 N=8 N=6 M0 M12 M24 N=24 N=8 N=6

  7. Best Practice phosphate Nijmegen 32% Too high Too low according to ESPN 58% 43% 29% 57% 71% 10% M0 N=31 M12 N=14 M24 N=7

  8. Protocol development - study group + best practice hospital - consensus - applicable in all centres • Implementation • Qoc improvement?

  9. Indicators PTH Calcium CAXP Lipids

  10. Benchmark iPTH

  11. Too high Too low iPTH

  12. Best Practice (iPTH ) Too high Too low Amsterdam HD PD

  13. Benchmark: 16-33 pmol/l (145-300) • Target???

  14. Proposal Calcium ? mg/dL

  15. Too high Too low According to ESPN Calcium 11% 12%

  16. Best practice Liege HD PD

  17. Proposal CaXP ? mg/dL

  18. Proposal all lipids - Cholesterol ( Total, LDL, HDL) - Triglycerides

  19. LDL cholesterol (<100 mg/dl)

  20. HDL cholesterol (<35mg/dl)

  21. 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)

  22. 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?

  23. Questions/remarks?

  24. Proposal CRP< ? Mg/L

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