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S 20 Parallel Session
Programme of the Session
Title: Paediatric renal care
GS: Rita Van Damme – Lombaerts (Belgium)
Growth in children before and after renal transplantation: therapeutic options and results
O 43
Improved understanding of uraemic toxicity for management of chronic kidney disease in paediatric patients
Sunny Eloot (Belgium)
O 44
The role of the nurse in the management of kidney injury due to Haemolytic Uremic Syndrome
Sayan Canan (Turkey)
O 45
Paediatric nurses perception of barriers to the creation of AVFs in children on haemodialysis Manal Hamoudeh
(United Arab Emirates)
O 46
The pain-reducing effect of Camera Flash Light for arteriovenous fistula in children
Sema Unturk (Turkey)
Abstracts
GUEST SPEAKER
Growth in children before and after renal transplantation: therapeutic options and results
R. Van Damme-Lombaerts
Growth retardation is very common in children with advanced CKD. After a succesfull transplantation (Tx) the expected catch-up growth does not always occur. Recent European studies demonstrate that final height (FH) is below percentile 3 in 50% of children requiring RRT below the age of 13 yrs (ESPN/ERA-EDTA registry 2014). Better medical and nutritional approach is essential to overcome growth failure in CKD. rGH (recombinant growth hormone) therapy is available since more than 20 years and improves growth in all stages of CKD, the best in the younger age group. Respons is diminished during dialysis. After Tx, steroid minimisation is essential before rGH therapy is started. rGH treatment causes few adverse events . After Tx the incidence of rejection is not clearly increased following rGH.
The price of rGH is varying from one product to another by 25% and is expensive: around 10.000 à 12.000 Euro/year/child . This is justified since short stature has major consequences for quality of life and self esteem.
Even in 2016 rGH is not reimbursed in all countries of the EU and the specific conditions for reimbursement vary considerably.
Conclusion
Undertreatment of growth failure in CKD patients is still a problem resulting in dissatisfaction with body height in young adults. Long term rGH treatment results in an increased FH. All efforts should be done to start rGH at young age before puberty and before RRT. Adjustment of reimbursement between different EU countries is necessary.
BIOGRAPHY OF THE GUEST SPEAKER
O 43
Improved understanding of uraemic toxicity for management of chronic kidney disease in paediatric patients
E. Snauwaert1, E. Holvoet2, J. Van Helleputte2, J. Vande Walle1, A. Raes1, W. Van Biesen2, S. Eloot2
1Paediatric Nephrology, Ghent University Hospital, Gent, Belgium; 2Nephrology, Ghent University Hospital, Gent, Belgium
Background
Chronic kidney disease (CKD) in childhood is a devastating disease characterised by decreased life expectancy and important comorbidities negatively impacting the quality of life and integration in society. Retention of uraemic toxins is accepted to play a major role in the pathogenesis of the comorbidities, but studies in children are lacking. Furthermore, there are currently no good tools to monitor therapy adequacy, resulting in suboptimal management.
Objectives
The scientific objective of our four years project (started Oct 1st, 2015), is to provide the clinician with new diagnostic and therapeutic tools for the management of children with CKD, based on improved understanding of uraemic toxicity.
Methods
New uraemic toxin marker(s) are derived based on 1) associations between concentrations of an array of uraemic toxins with different comorbidities in CKD children, i.e. growth, QoL, cardiovascular factors, sleep and psychosocial functioning; and 2) simulations of the kinetics of these toxins in children on haemodialysis. The kinetic models are validated based on toxin concentrations and their relation to comorbidities in individual patients after an 'intervention', i.e. switching to a different strategy. Finally, an open access prediction simulator (PAEDSIM) based on patient characteristics and toxin marker concentrations is developed to optimise and individualise dialysis therapy.
Conclusion/Application to practice
By providing clinicians with more advanced tools to improve management of children with CKD, i.e. better assessment of renal dysfunction and start of therapy, and more accurate monitoring of dialysis adequacy, we aim to improve neurocognitive and psychosocial functioning (short term), growth and social integration (median term) and survival (long term).
O 44
The role of the nurse in the management of kidney injury due to HUS
C. Sayan1, E. Bulbul2, M. Pecen1, I. Salter1, N. Goknar3, F. Oktem3, M. Gursu4, R. Erkoc4, R. Kazancioglu4
1Department of Internal Medicine (dialysis), Bezmialem Vakif University, Istanbul, Turkey; 2Health Science Faculty, Department of Nursing, Bezmialem Vakif University, Istanbul, Turkey; 3Department of Pediatric Nephrology, Bezmialem Vakif University, Istanbul, Turkey; 4Department of Nephrology, Bezmialem Vakif University, Istanbul, Turkey
Background
Hemolytic Uremic Syndrome (HUS) is the most common cause of sudden, short term acute renal failure in children. Haemodialysis (HD) and peritoneal dialysis (PD) are treatment options for these patients.
Objectives
The purpose of the study is to share our experience with acute kidney injury in children due to HUS.
Methods
Data of patients who had HD, PD or continuous veno-venous hemodiafiltration due to acute kidney injury secondary to HUS between September 1st 2015 and October 1st 2015 were collected.
Results
Five patients were followed up within this period of time. All of the patients presented after an acute attack of diarrhea and were accepted to have typical HUS. The mean age was 6.2 years. Hemodiafiltration was performed in three patients in intensive care unit followed by PD in two patients and HD in one patient in pediatric nephrology clinic. One patient had only PD and one patient had only HD treatment. The number of haemodialysis sessions were 14 and 15. The mean duration on PD was 9.33 days. All patients’ renal functions improved completely and the patients were discharged form hospital in good health condition.
Conclusion/Application to practice
Nurses have a very important role in the management of acute dialysis in children. Nurses need to monitor vital sings, assess the hydration status, nutritional support, blood sampling, and educate patients and families. So, they should be familiar with the treatment options for hemolytic uremic syndrome.
O 45
Paediatric nurses perception of barriers to the creation of AVFs in children on haemodialysis
M. Hamoudeh1, N. Alqaissi2, D. Dowsett3, C. Greenway3, P. Byers3, A. Cullimore1, N. Richards1, M. Richards1
1Nursing, SEHA Dialysis Services, Abu Dhabi, United Arab Emirates; 2Nursing, Fatima College of Health Sciences, Abu Dhabi, United States; 3Health Faculty, De Montfort University, Leicester, United Kingdom
Background
The incidence and prevalence of end stage renal disease in paediatric populations is rising. Haemodialysis remains the most frequent modality of RRT in paediatric population. Vascular access is the cornerstone of HD. Selection and creation of the best vascular access is the most challenging aspect in the care of children on HD.
Objectives
The purpose of this study was to explore barriers perceived by renal paediatric nurses to the creation of AVF for children. The specific objectives were to: Conduct a comprehensive literature review. Assess the knowledge of the paediatric renal nurses with regards to haemodialysis vascular access. Suggest an evidence based service development plan to implement the use of AVF for the long term HD paediatric patients.
Methods
A descriptive, qualitative research design was used. A purposive sample of paediatric renal nurses was recruited from the paediatric HD unit, and data were collected and analyzed using a thematic analysis approach.
Results
Three related themes were identified: 1) nurses’ knowledge of paediatric HD vascular access based on experience, 2) perceived challenges to paediatric AVF creation and 3) the need for increased awareness and education of the benefits of AVF for paediatric patients.
Conclusion/Application to practice
These data aknowledge the longterm benefits of AVF in children. There is a need to focus on raising awareness and educating nurses with regards to AVF benefits.
O 46
The pain-reducing effect of Camera Flash Light for arteriovenous fistula in children
S. Unturk1, M. Anil2, N. Akcan1, A. Bal2, N. Aksu3, O. Yavascan3, M. Tanrisev1, S. Ersan1, A. Demir1, N. Demiroglu1
1Haemodialysis, Tepecik Teaching and Research Hospital, Izmir, Turkey; 2Pediatric Emergency Department, Tepecik Teaching and Research Hospital, Izmir, Turkey; 3Pediatric Nephrology, Tepecik Teaching and Research Hospital, Izmir, Turkey
Objectives
To investigate the positive effect of camera's flash light to reduce the pain due to AVF fistula insertion in children followed in chronic haemodialysis program.
Methods
11 pediatric patients in chronic haemodialysis treatment program for at least two months (median age: 15.5; minimum 11, maximum 18; male / female: 8/3) were evaluated. It was performed according to four different procedures applied to each haemodialysis session on different days. Session 1: AVF insertion without local anesthetic. Session 2: AVF insertion immediately after taking a photo without a flash from a distance of 2 m. Session 3: AVF insertion immediately after taking a photo with a flash from a distance of 2 m. Session 4: AVF insertion after lidocaine spray. Five minutes after the procedure, the patient and his/her mother evaluated the severity of the pain in each session (Visual Analog Scale: ranges from scoring 0-10. 0 = no pain; 10 = worst pain I remember).
Results
The median pain scores of children were 8, 4, 2, 2 in session 1, 2, 3 and 4 (p = 0.01), respectively. The median pain scores of the mothers were 8, 5, 3, 2 in session 1, 2, 3 and 4 (p <0.001) respectively.
Conclusion/Application to practice
Taking a photograph with flash light was an effective and simple method for reducing the pain severity due to arteriovenous fistula insertion in children followed in chronic haemodialysis program.