American Society of Pediatric Nephrology Position Paper: Standard Resources Required for a Pediatric Nephrology Practice

Abstract

This document aims to describe the essential resources needed for all pediatric nephrology divisions, regardless of the number of pediatric nephrologists in the division. The recommendations in this position paper are the work of authors representing the American Society of Pediatric Nephrology (ASPN) and are endorsed by the ASPN Council

Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment

“…For safe HD of children, more frequent clinical assessment is necessary [193]. Therefore, HD for children often requires a nurse-to-patient ratio of 1:1 [194].…”

ESRD Policies and the Delivery of Pediatric Long-term Dialysis Care in the United States

“…5 J o u r n a l P r e -p r o o f pediatric dialysis care requires much more intense supervision not only from parents or guardians, but also from pediatric nephrologists, dialysis nurses, technicians, social workers, Child Life specialists (CLS) and dietitians, all with specialized knowledge of changing needs for age, growth, development and underlying disease. 6,12 Gastrostomy tube feedings and growth hormone therapy are frequently needed to provide adequate nutrition and achieve statural growth. 5,6 Frequent assessment and dietary adjustments for changes in target weight due to growth or weight loss are imperative.…”

“…Staffing for hemodialysis (HD) treatments for small size, short attention span or behavioral issues usually needs to be 1:1 or 1:2 to provide safe care. 6,12 Home PD care often requires more than one monthly visit and frequent telephone support for family caregivers. 12 Caregiver, especially parent, burnout and family dysfunction is common and requires identification and extra multidisciplinary team support.…”

“…6,12 Home PD care often requires more than one monthly visit and frequent telephone support for family caregivers. 12 Caregiver, especially parent, burnout and family dysfunction is common and requires identification and extra multidisciplinary team support. 13,14 Most pediatric dialysis facilities use CLS to promote developmentally appropriate adjustment to the medical environment, teachers to liaison with schools to optimize ongoing education, behavioral specialists to help manage difficult behavior and psychologists to deal with psychosocial disruption of normal childhood and family life.…”

“…13,14 Most pediatric dialysis facilities use CLS to promote developmentally appropriate adjustment to the medical environment, teachers to liaison with schools to optimize ongoing education, behavioral specialists to help manage difficult behavior and psychologists to deal with psychosocial disruption of normal childhood and family life. 6,[12][13][14] Pediatric surgeons and urologists must be available for HD or PD access with attention to lifetime access site preservation, gastrostomy tubes and rehabilitation of the urinary tract for successful transplantation. 6 Coordination of care for other medical comorbidities and for developmentally appropriate physical, occupational and speech therapy creates additional complexity, but has led to improved pediatric outcomes, fewer lifelong medical complications and lower long-term healthcare expenditures.…”