Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
INWT Statistics GmbH, Berlin, Germany.
Pediatr Nephrol. 2018 Apr;33(4):705-712. doi: 10.1007/s00467-017-3831-0. Epub 2017 Nov 4.
In patients on conventional hemodialysis (HD), morbidity is high and quality of life is poor. Intensified HD programs have been developed to help overcome these shortcomings, , but very few pediatric dialysis centers have reported the implementation of such a HD program.
An online survey was sent to all 221 pediatric dialysis centers which participate in the International Pediatric Dialysis Network (IPDN). The aim of the survey was to assess the attitude of pediatric nephrologists towards intensified HD, the penetrance of intensified HD into their clinical practice and barriers to implementation.
Of the 221 pediatric dialysis centers sent the survey, respondents from 61% (134) replied. Among these respondents, 69% acknowledged being aware of the evidence in support of the use of intensified HD, independent of whether intensified HD was offered at their own center, and 50% associated the use of daily nocturnal HD with the best overall patient outcome. In contrast, only 2% of respondents were in favor of conventional HD. Overall, 38% of the respondents stated that at their center intensified HD is prescribed to a subgroup of patients, most commonly in the form of short daily HD sessions. The most important barriers to expansion of intensified HD programs were lack of adequate funding (66%) and shortage of staff (63%), whereas lack of expertise and of motivation were reported infrequently as obstacles (21 and 14%, respectively).
Intensified HD is considered by many pediatric nephrologists to be the dialysis modality most likely associated with the best patient outcome. The limited use of this treatment approach highlights the importance of defining and successfully addressing the barriers to implementation.
在接受常规血液透析（HD）的患者中，发病率较高，生活质量较差。已经开发出强化 HD 方案来帮助克服这些缺点，但是很少有儿科透析中心报告实施这种 HD 方案。
向参与国际儿科透析网络（IPDN）的所有 221 个儿科透析中心发送了在线调查。该调查的目的是评估儿科肾病医生对强化 HD 的态度、强化 HD 在其临床实践中的普及程度以及实施的障碍。
在发送调查的 221 个儿科透析中心中，有 61%（134 个）的中心做出了回应。在这些回应者中，69%的人承认了解支持使用强化 HD 的证据，无论他们自己的中心是否提供强化 HD，50%的人将每日夜间 HD 与最佳整体患者结局联系起来。相比之下，只有 2%的受访者赞成常规 HD。总体而言，38%的受访者表示，在他们的中心，强化 HD 方案被规定用于一组患者，最常见的形式是短期每日 HD 治疗。扩大强化 HD 计划的最重要障碍是缺乏足够的资金（66%）和人手不足（63%），而缺乏专业知识和动力被认为是障碍的情况很少（分别为 21%和 14%）。
许多儿科肾病医生认为强化 HD 是最有可能与最佳患者结局相关的透析方式。这种治疗方法的应用有限突出了定义和成功解决实施障碍的重要性。
