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. 2025 Jun;40(6):2043-2051.
doi: 10.1007/s00467-025-06667-8. Epub 2025 Jan 23.

Survey of legislative frameworks and national recommendations governing paediatric maintenance haemodialysis in Europe

Enzo Vedrine  1 , Claus Peter Schmitt  2 , Johan Vande Walle  3 , Diamant Shtiza  4 , Klaus Arbeiter  5 , Evelien Snauwaert  3 , Danka Pokrajac  6 , Dimitar Roussinov  7 , Danko Milosevic  8 , Elia Avraam  9 , Jakub Zieg  10 , Ida Maria Schmidt  11 , Ylle Toots  12 , Tuula Holtta  13 , Günter Klaus  14 , Varvara Askiti  15 , Kalman Tory  16 , Clodagh Sweeney  17 , Enrico Verrina  18 , Edite Jeruma  19 , Augustina Jankauskiene  20 , Valerie Said Conti  21 , Branko Lutovac  22 , Linda Koster-Kamphuis  23 , Velibor Tasic  24 , Anna Kristina Bjerre  25 , Maria Szczepańska  26 , Alberto Caldas Afonso  27 , Andreea Liana Rãchişan  28 , Brankica Spasojevic  29 , Victor Janko  30 , Gregor Novljan  31 , Pedro J Ortega  32 , Lisa Sartz  33 , Sibylle Tschumi  34 , Sevcan Azime Bakkaloglu  35 , Jan Dudley  36 , Dymtro D Ivanov  37 , Rukshana Shroff  38 , Bruno Ranchin  39 ; with the support of the EPDWG, ERKNet and ESPN dialysis working groups
Affiliations

Survey of legislative frameworks and national recommendations governing paediatric maintenance haemodialysis in Europe

Enzo Vedrine et al. Pediatr Nephrol. 2025 Jun.

Abstract

Background: The application of international recommendations for paediatric maintenance haemodialysis (HD) could be strengthened by national laws or written recommendations. Our aim was therefore to describe the national rules governing paediatric maintenance HD in European countries.

Methods: A national representative, approved by the president of each paediatric nephrology society, was contacted in all 42 European countries to complete two online questionnaires.

Results: Answers were received from 36 countries. The population served by HD centres varies from 83,000 to 1,197,000 residents below 18 years of age and the estimated mean number of children on HD per centre from 0.2 to 13.5. The lowest age at which a child can be dialysed in an adult centre varies from 0 to 18 years. Laws or written national recommendations specifying: this age, the need for a paediatrician as part of medical team in mixed adult-paediatric centres, the minimum number of doctors per centre and the number of patients per nurse or nurse's aide required during sessions exist in only 25, 22, 22, 44 and 8% of the countries, respectively. Similarly, dietitians, social workers, school service, psychologists and play specialists/youth workers are required by law or written national recommendations in 36, 28, 36, 31 and 14% of countries, respectively.

Conclusion: Laws or written national recommendations for paediatric maintenance HD are rare in European countries and very heterogeneous when they exist. This calls for discussion among paediatric and adult nephrologists and health authorities on the organisation of safe and effective paediatric HD practices.

Keywords: Child; Legal status; Maintenance haemodialysis; Recommendations; Survey.

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Conflict of interest statement

Declarations. Authors do not have any financial or non-financial interests that are directly or indirectly related to this work.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
Number of paediatric residents (< 18 years of age) per dialysis centre providing paediatric maintenance haemodialysis in European countries
Fig. 2
Fig. 2
Minimal patient age required for maintenance haemodialysis in adult dialysis centres, in the 36 European countries
Fig. 3
Fig. 3
Type of rules governing maintenance paediatric haemodialysis (HD) in Europe: percentage of countries with each type of rules or without rules
See this image and copyright information in PMC

References

    1. Bonthuis M, Vidal E, Bjerre A et al (2021) Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. Pediatr Nephrol 36:2337–2348. 10.1007/s00467-021-04928-w - DOI - PMC - PubMed
    1. Van Stralen KJ, Borzych-Dużalka D, Hataya H et al (2014) Survival and clinical outcomes of children starting renal replacement therapy in the neonatal period. Kidney Int 86:168–174. 10.1038/ki.2013.561 - DOI - PubMed
    1. Ranchin B, Schmitt CP, Warady B et al (2023) Devices for long-term hemodialysis in small children-a plea for action. Kidney Int 103:1038–1040. 10.1016/j.kint.2023.03.018 - DOI - PubMed
    1. Ranchin B, Schmitt CP, Warady BA et al (2024) Technical requirements and devices available for long-term hemodialysis in children—mind the gap! Pediatr Nephrol 39:2579–2591. 10.1007/s00467-023-06233-0 - DOI - PubMed
    1. Fischbach M, Edefonti A, Schröder C et al (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066. 10.1007/s00467-005-1876-y - DOI - PMC - PubMed