Consensus procedure for the management of children with esrd
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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

Consensus procedure for the management of children withESRD

Oct 2011


Aim

Defining consensus-based benchmarks


Indicators

Hemoglobin

Blood pressure

Phosphate

PTH

Calcium

CaXP

Lipids

Implementation

Benchmark

Indicators


Best practice hb
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



Best practice bp
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


Best practice phosphate
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


  • Protocol development

    - study group + best practice hospital

    - consensus

    - applicable in all centres

  • Implementation

  • Qoc improvement?


Indicators

PTH

Calcium

CAXP

Lipids



Too high

Too low

iPTH


Best practice ipth
Best Practice (iPTH )

Too high

Too low

Amsterdam

HD

PD




Calcium

Too high

Too low

According to ESPN

Calcium

11%

12%


Best practice
Best practice

Liege

HD

PD



Proposal all lipids
Proposal all lipids

- Cholesterol ( Total, LDL, HDL)

- Triglycerides


Ldl cholesterol 100 mg dl
LDL cholesterol (<100 mg/dl)


Hdl cholesterol 35mg dl
HDL cholesterol (<35mg/dl)


Definitions
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)


To do
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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