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Consensus procedure for the management of children with ESRD

Consensus procedure for the management of children with ESRD. Questions/aims. Aim Defining consensus-based benchmarks Do we agree with the current guidelines for the management of ESRD in children? Are there any gaps? What needs to be improved?. Questions:. Do we/you know the guideline?

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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

  2. Questions/aims Aim Defining consensus-based benchmarks • Do we agree with the current guidelines for the management of ESRD in children? • Are there any gaps? • What needs to be improved?

  3. Questions: • Do we/you know the guideline? • Do we/you agree with it? • What are the limitations? • Do we/you use it? • If so, is this visible in the results? • What needs to be improved?

  4. Hemoglobin Blood pressure Phosphate PTH (target) Calcium CaXP Dyslipidemia Benchmark Indicators

  5. Hemoglobin Lower treshold: < 2 yr: 10 g/dl or 6.2 mmol/l > 2 yr: 11 g/dl or 6.8 mmol/l Upper threshold: normal value for age Target: 70%

  6. Hb 12% 15% 41% Hb too high Anemia 12% 8% 50% 47% 46% 4% 38% 52% 44% 40%

  7. Best practice i 13% Hb too high Anemia 52% 7% 71% 35% 83% 22% M0 N=31 M12 N=14 M24 N= 6

  8. Blood Pressure(diastolic and systolic) < p95 for age, gender and height According to the Task Force Report 2004 Target: 75%

  9. Blood pressure 25% > p95 38% 24% 38% 75% 19% 38% 17% 33% 62% 81% 35% 22% 62% 78% 65%

  10. Best Practice 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

  11. Phosphate normal values for age (ESPN)

  12. Phosphate 25% Too high Too low Age corrected 40% 39% Too high Too low according to ESPN 53% 30% 38% 36% 55% 48% 39% 8% 7% 13%

  13. Best Practice phosphate 32% Too high Too low according to ESPN 58% 43% 17% 57% 83% 10% M0 N=31 M12 N=14 M24 N=6

  14. Indicators PTH Target Calcium Benchmarks Dyslipidemia

  15. Proposal iPTH ? pg/mL

  16. iPTH 24% Too high Too low According to KDOQI 24% 33% 52% 25% 43% 42% 14% 43%

  17. Best Practice (iPTH) 7% 37% Too high Too low 14% 43% 56% 25% 43% 50% 25% M0 M12 M24 N=30 N= 14 N=4

  18. Target???

  19. Proposal Calcium ? mg/dL

  20. Calcium (ESPN) 11% 10% Too high Too low According to ESPN 76% 19% 12% 80% 19% 14% 77% 1% 4%

  21. Best practice Too high Too low According to ESPN 70% 100% 30% N=10 N=4

  22. Proposal CaXP ? mg/dL

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

  24. Total cholesterol 24% Too high According to ESPN 13% 17% )

  25. LDL cholesterol 22% Too high> 110 mg/dl 16% 19%

  26. HDL cholesterol Too low< 35 mg/dl 24% 35% 39%

  27. Triglycerides (not after fasting!) 60% 75% 61% ESPN handbook 2002, after 12 h fasting! Age and gender corrected

  28. Questions/remarks?

  29. Proposal CRP< ? Mg/L

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