title: Factors influencing choice of renal replacement therapy in European paediatric nephrology units.
abstract: BACKGROUND
  Many factors may impact upon choice of renal replacement therapy (RRT) for children and adolescents, including patient and family choice, patient size and distance from the renal centre as well as logistic issues such as facilities and staffing at the unit. We report a survey of factors influencing treatment choice in 14 European paediatric nephrology units.
  
  
  METHODS
  A questionnaire was developed by consensus and completed by 14 members of the European Paediatric Dialysis Working Group on facilities, staffing and family assessments impacting on choice of therapy as well as choice of therapy for 97 patients commencing initial RRT in 2011.
  
  
  RESULTS
  All units offered all modalities of RRT, but there were limitations for pre-emptive transplantation (PET) and largely adult surgical dependence for creation of arteriovenous fistulae and transplantation. The average waiting time for a deceased donor kidney was 18.5 (range 3-36) months. Full time dietetic support was available in six of the 14 units. There was no social worker, psychology, play therapy or teaching support in three, two, seven and four units, respectively. Assessment by other members of the multidisciplinary team and home visits before choice of therapy was carried out in 50 % of units, and although all patients were discussed at team meetings, the medical opinion predominated. In terms of types of RRT, 50 % of patients were commenced on chronic peritoneal dialysis (PD), 34 % on haemodialysis (HD) and 16 % underwent pre-emptive transplantation (PET). Chronic PD predominated in patients aged <5 years and HD predominated in those aged >10 years. Patient and family choice and age or size of patient were predominant factors in choice of therapy with a predictable decline in renal function favouring PET and social factors HD.
  
  
  CONCLUSIONS
  Chronic peritoneal dialysis predominated as primary choice of RRT, especially in younger children. The PET rates remain low. The influence of surgeons predominanted, and national transplant rules may be significant. Most units had insufficient multiprofessional support, which may impact upon initial choice of therapy as well as sustaining families through RRT.
authors.affiliation: Children's Renal & Urology Unit, Nottingham Children's Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK, judith.hayes@nuh.nhs.uk.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Watson
authors.forename: Wesley N
authors.initials: WN
authors.lastname: Hayes
authors.forename: Karel
authors.initials: K
authors.lastname: Vondrak
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
authors.forename: Mesiha
authors.initials: M
authors.lastname: Ekim
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.forename: Rukshana
authors.initials: R
authors.lastname: Shroff
authors.forename: Tuula
authors.initials: T
authors.lastname: Holta
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zurowska
authors.forename: Gunter
authors.initials: G
authors.lastname: Klaus
authors.forename: Sevan
authors.initials: S
authors.lastname: Bakkaloglu
authors.forename: Constantinos J
authors.initials: CJ
authors.lastname: Stefanidis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Stefanidos
authors.forename: Johan
authors.initials: J
authors.lastname: Van de Walle
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D009398:Nephrology / Q000379:methods*; D064686:Nutritionists; D010348:Patient Care Team; D057240:Patient Preference; D018579:Patient Selection; D010561:Personnel Staffing and Scheduling; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods*; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists; D000078329:Workforce