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.

Center for Pediatric and Adolescent Medicine University Hospital Heidelberg Heidelberg Germany

Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant Hospices Civils de Lyon 59 boulevard Pinel 69677 Bron Cedex France

Centro Materno Infantil do Norte Centro Hospitalar Universitario de Santo António Porto Portugal

Chair and Department of Pediatrics Faculty of Medical Sciences in Zabrze Medical University of Silesia Katowice Poland

Department of Nephrology and Renal Replacement Therapy Shupyk National Health Care University Kiev Ukraine

Department of Nephrology Dialysis and Transplantation University Children's Hospital Belgrade Serbia

Department of Nephrology P and A Kyriakou Children's Hospital Athens Greece

Department of Pediatric and Adolescent Medicine Medical University Vienna Vienna Austria

Department of Pediatric Nephrology and Transplantation The New Children's Hospital HUS Helsinki University Hospital Helsinki Finland

Department of Pediatric Nephrology Bristol Children's Hospital Bristol UK

Department of Pediatric Nephrology Ghent University Hospital Ghent Belgium

Department of Pediatric Nephrology Hospital Universitari La Fe Valencia Spain

Department of Pediatric Nephrology Mother Teresa Hospital Tirana Tirana Albania

Department of Pediatric Nephrology Radboud University Medical Center Radboud Institute for Molecular Life Sciences Amalia Children's Hospital Nijmegen the Netherlands

Department of Pediatric Tallinn Children's Hospital Tallinn Estonia

Department of Pediatrics 2 University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca Romania

Department of Pediatrics 2nd Faculty of Medicine Charles University Prague and Motol University Hospital 5 Úvalu 84 15006 Praha 5 Czech Republic

Department of Pediatrics and Adolescent Medicine University Hospital Rigshospitalet Copenhagen Denmark

Department of Pediatrics Archbishop Makarios 3 Hospital Nicosia Cyprus

Department of Pediatrics Mater Dei Hospital Malta Msida Malta

Department of Pediatrics Pediatric Nephrology Inselspital University of Berne Berne Switzerland

Department of Pediatrics Skane University Hospital Lund University Lund Sweden

Division of Nephrology Dialysis and Transplantation Instituto di ricovero e cura a carattere scientifico Instituto Giannina Gaslini Children's Hospital Genoa Italy

Division of Pediatric Nephrology Department of Pediatrics Gazi University Faculty of Medicine Ankara Turkey

Institute for Children's Diseases Clinical Center of Montenegro Prodgorica Montenegro

KfH Pediatric Kidney Center and Department of Pediatrics Philipps University Marburg Germany

Medical Faculty Skopje University Children's Hospital Skopje Macedonia

Medimpax Bratislava Slovakia

National Pediatric Hemodialysis Centre and Renal Transplant Unit Temple Street Children's University Hospital Dublin Ireland

Pauls Stradiņš Clinical University Hospital Pilsoņu iela 13 Zemgales priekšpilsēta Rīga LV 1002 Latvia

Pediatric Centre MTA Centre of Excellence Semmelweis University Budapest Hungary

Pediatric Clinic Clinical Centre University of Sarajevo Sarajevo Bosnia and Herzegovina

Pediatric Nephrology Department Children's Hospital University Medical Centre Ljubljana Ljubljana Slovenia

Pediatric Nephrology Oslo University Hospital Rikshospitalet Oslo Norway

SBAL Pediatric Diseases Nephrology and Hemodialysis Clinic Department of Pediatrics Medical University of Sofia 1606 Sofia Bulgaria

UCL Great Ormond Street Hospital and Institute of Child Health London UK

University of Zagreb School of Medicine University Hospital Center Zagreb Zagreb Croatia

Vilnius University Children Hospital Affiliate of Vilnius University Hospital Santariskiu klinikos Santariskiu 4 08406 Vilnius LT Lithuania

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