BACKGROUND: Data on the immunization practices in pediatric chronic kidney disease (CKD) patients are scarce. The purpose of this study was to evaluate current vaccination practices for children on dialysis across European pediatric nephrology centers. METHODS: A total of 18 tertiary pediatric nephrology centers from 12 European countries were included in the study. The data on universal national immunization programs and immunization practices for children with chronic disease or risk were recorded from European Center for Disease Prevention and Control and the World Health Organization. The immunization practices and center protocols for monitoring antibody titers after vaccination in dialysis patients were obtained through a questionnaire. RESULTS: All centers included in the study recommended immunization against hepatitis B virus (HBV), diphtheria, tetanus, pertussis, Hemophilus influenzae type b (Hib), poliomyelitis, measles, mumps, rubella (MMR), and streptococcus pneumonia in dialysis patients. In 16 centers, dialysis patients were vaccinated against influenza virus annually. HBV protective antibody titers were measured in 17 centers (during dialysis period in 14 centers, during pre-renal transplantation preparations in 14 centers or in both times in 11 centers). Hepatitis A virus (HAV) was reported to be followed in 13 centers, in 8 centers during dialysis period, and in 11 centers during pre-RTx preparations. MMR and varicella-zoster virus (VZV) protective antibody titers were measured during the dialysis period or before renal transplantation (RTx) in 12 and 15 centers, respectively, and in 6 centers both titers were checked both times. CONCLUSION: There are variations in vaccination practice across Europe. Children with CKD, those undergoing dialysis, and transplant candidates should receive age-appropriate vaccinations before RTx as well as before the transition to adult nephrology clinics and antibody levels should be monitored to evaluate the immunization status before and after RTx.

• Klíčová slova
• Children, Dialysis, Immunization, Vaccination,
• MeSH
• chronická renální insuficience komplikace   terapie   MeSH
• dialýza ledvin * MeSH
• dítě MeSH
• kojenec MeSH
• lékařská praxe - způsoby provádění MeSH
• lidé MeSH
• mladiství MeSH
• nefrologie MeSH
• pediatrie MeSH
• předškolní dítě MeSH
• protilátky analýza   MeSH
• průzkumy a dotazníky MeSH
• vakcinace statistika a číselné údaje   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• protilátky MeSH

BACKGROUND: Previous studies investigating hospitalizations in dialysis patients have focused primarily on patient-centered factors. We analyzed the impact of hospital and dialysis unit characteristics on pediatric dialysis patients' hospitalizations for access-related complications (ARCs). METHODS: This cross-sectional study involved 102 hemodialysis (HD) and 163 peritoneal dialysis (PD) patients. Data between July 2017 and July 2018 were analyzed. RESULTS: Children's hospitals (CHs) had more pediatric nephrologists and longer PD experience (years) than general hospitals (GHs) (p = 0.026 and p = 0.023, respectively). A total of 53% of automated PD (APD) and 6% of continuous ambulatory PD (CAPD) patients were in CHs (p < 0.001). Ninety-three percent of APD and 69% of CAPD patients were treated in pediatric-specific PD units (p = 0.001). CHs had a higher prevalence in providing hemodiafiltration (HDF) than GHs (83% vs. 30%). Ninety-seven percent of HDF vs. 66% for conventional HD (cHD) patients, and 94% of patients with arteriovenous fistula (AVF) vs. 70% of those with central venous catheters (CVC), were dialyzed in pediatric-specific HD units (p = 0.001 and p = 0.016, respectively). Eighty patients (51 PD and 29 HD) had 135 (84 PD, 51 HD) hospitalizations. CAPD was an independent risk factor for hospitalizations for infectious ARCs (I-ARCs) (p = 0.009), and a health center's PD experience negatively correlated with CAPD patient hospitalizations for I-ARCs (p = 0.041). cHD and dialyzing in combined HD units significantly increased hospitalization risk for non-infectious (NI-)ARCs (p = 0.044 and p = 0.017, respectively). CONCLUSIONS: CHs and pediatric-specific dialysis units have higher prevalence of APD and HDF use. Hospitalizations for I-ARCs in CAPD are lower in centers with longer PD experience, and pediatric HD units are associated with fewer hospitalizations due to NI-ARCs. A higher resolution version of the Graphical abstract is available as Supplementary information.

• Klíčová slova
• Access-related complications, Children, Dialysis, Dialysis unit, Hospital, Hospitalization,
• MeSH
• chronické selhání ledvin * epidemiologie   terapie   MeSH
• dialýza ledvin škodlivé účinky   MeSH
• dítě MeSH
• hospitalizace MeSH
• lidé MeSH
• nemocnice MeSH
• peritoneální dialýza * MeSH
• průřezové studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

In the submitted review the authors give an account of contemporary problems of membranes for dialysis available at present. Although the authors mention also cellulose based membranes (membranes made from unmodified regenerated cellulose, synthetic modified cellulose membranes produced by chemical transformation of cellobiose), the main attention is paid to polymer membranes--typical synthetic polymers, i.e. polysulphone (PSu), polyacrinon nitrate (PAN), polyamide (PA), ethyl vinyl alcohol polymers (EVAL), polyester mixtures formed by polyacrylonitrile and polyether sulphone (PEPA). The authors describe their adsorption capacity, possibility of sterilization and specific problems of interaction with different drugs. In the conclusion the authors outline demands on the development of modern membranes and their problems in future.

• MeSH
• dialýza ledvin přístrojové vybavení   MeSH
• lidé MeSH
• membrány umělé * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• membrány umělé * MeSH

BACKGROUND: Pleural or pericardial effusions secondary to pleuro-peritoneal fistula (PPF) and pericardio-peritoneal fistula (PcPF) are rare but serious complications of peritoneal dialysis (PD). METHODS: We conducted a 10-year survey across all participating centres in the European Paediatric Dialysis Working Group to review the incidence, diagnostic techniques, therapeutic options and outcome of children on chronic PD with PPF and/or PcPF. RESULTS: Of 1506 children on PD there were ten cases (8 of PPF, 1 each of PcPF and PPF + PcPF), with a prevalence of 0.66%. The median age at presentation was 1.5 [inter-quartile range (IQR) 0.4-2.4] years, and nine children were <3 years. The time on PD before onset of symptoms was 4.3 (IQR 1.3-19.8) months. Eight children had herniae and seven had abdominal surgery in the preceding 4 weeks. Symptoms at presentation were respiratory distress, reduced ultrafiltration and tachycardia. PD was stopped in all children; three were managed conservatively and thoracocentesis was performed in seven (with pleurodesis in 3). PD was restarted in only three children, in two of them with success. CONCLUSION: In conclusion, PPF and PcPF are rare in children on chronic PD, but are associated with significant morbidity, requiring a change of dialysis modality in all cases. Risk factors for PPF development include age of <3 years, herniae and recent abdominal surgery.

• Klíčová slova
• Children, Pericardial effusion, Pericardio-peritoneal fistula, Peritoneal dialysis, Pleural effusion, Pleuro-peritoneal fistula,
• MeSH
• ascitická tekutina patologie   MeSH
• chronické selhání ledvin terapie   MeSH
• dítě MeSH
• incidence MeSH
• kojenec MeSH
• lidé MeSH
• perikardiální efuze epidemiologie   etiologie   MeSH
• peritoneální dialýza škodlivé účinky   MeSH
• píštěle epidemiologie   etiologie   MeSH
• pleurální výpotek epidemiologie   etiologie   MeSH
• předškolní dítě MeSH
• prevalence MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: COVID-19 was declared a global health emergency. Since children are less than 1% of reported cases, there is limited information to develop evidence-based practice recommendations. The objective of this study was to rapidly gather expert knowledge and experience to guide the care of children with chronic kidney disease during the COVID-19 pandemic. METHODS: A four-round multi-center Delphi exercise was conducted among 13 centers in 11 European countries of the European Pediatric Dialysis Working Group (EPDWG) between March, 16th and 20th 2020. Results were analyzed using a mixed methods qualitative approach and descriptive statistics. RESULTS: Thirteen COVID-19 specific topics of particular need for guidance were identified. Main themes encompassed testing strategies and results (n = 4), changes in use of current therapeutics (n = 3), preventive measurements of transmission and management of COVID-19 (n = 3), and changes in standard clinical care (n = 3). Patterns of center-specific responses varied according to regulations and to availability of guidelines. CONCLUSIONS: As limited quantitative evidence is available in real time during the rapid spread of the COVID-19 pandemic, qualitative expert knowledge and experience represent the best evidence available. This Delphi exercise demonstrates that use of mixed methodologies embedded in an established network of experts allowed prompt analysis of pediatric nephrologists' response to COVID-19 during this fast-emerging public health crisis. Such rapid sharing of knowledge and local practices is essential to timely and optimal guidance for medical management of specific patient groups in multi-country health care systems such as those of Europe and the US.

• Klíčová slova
• COVID-19, Delphi, Dialysis, Pandemic, Transplantation,
• MeSH
• chronická renální insuficience komplikace   terapie   MeSH
• COVID-19 MeSH
• delfská metoda MeSH
• dialýza ledvin * MeSH
• dítě MeSH
• kojenec MeSH
• kontrola infekce MeSH
• koronavirové infekce komplikace   prevence a kontrola   terapie   MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• mladiství MeSH
• pandemie prevence a kontrola   MeSH
• předškolní dítě MeSH
• virová pneumonie komplikace   prevence a kontrola   terapie   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

Dialysate conductivity is routinely used as a surrogate for dialysate sodium concentration. However, dialysis machine manufacturers apply different conductivity temperature correction coefficients. With the same conductivity in dialysis machines manufactured by different manufacturers, dialysate sodium may significantly differ. Also, electrolyte prescriptions are individualized (K, Ca, HCO3) and this is associated with another variation in dialysate sodium in the order of 1-5 mmol/L and both deviations are cumulative and chronic for each patient. Equivalence of the prescribed dialysate sodium and the concentration measured in it is not granted. Both variables differ and it is machine dependent! This paper analyses those variations from a technical point of view and suggests how to detect them and how to deal with or avoid them in clinical practice.

• Klíčová slova
• Conductivity cell monitoring, Dialysate conductivity, Dialysate sodium, Dialysate sodium correction, Dialysis sodium prescription,
• MeSH
• dialýza ledvin MeSH
• dialyzační roztoky chemie   MeSH
• elektrická vodivost MeSH
• lidé MeSH
• nevhodné předepisování MeSH
• sodík analýza   normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• dialyzační roztoky MeSH
• sodík MeSH

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some.Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

• Klíčová slova
• AV fistula, dialysis, dialysis access-related distal ischaemia, techniques and procedures, ultrasonography–Doppler evaluation,
• MeSH
• arteriovenózní zkrat * škodlivé účinky   MeSH
• dialýza ledvin MeSH
• ischemie diagnostické zobrazování   etiologie   terapie   MeSH
• lidé MeSH
• ligace MeSH
• průchodnost cév MeSH
• ruka MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• časové faktory MeSH
• dialýza ledvin metody   MeSH
• lidé MeSH
• osmolární koncentrace MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: The unphysiological composition of peritoneal dialysis (PD) fluids induces progressive peritoneal fibrosis, hypervascularization and vasculopathy. Information on these alterations after kidney transplantation (KTx) is scant. METHODS: Parietal peritoneal tissues were obtained from 81 pediatric patients with chronic kidney disease stage 5 (CKD5), 72 children on PD with low glucose degradation product (GDP) PD fluids, and from 20 children 4-8 weeks after KTx and preceding low-GDP PD. Tissues were analyzed by digital histomorphometry and quantitative immunohistochemistry. RESULTS: While chronic PD was associated with peritoneal hypervascularization, after KTx vascularization was comparable to CKD5 level. Submesothelial CD45 counts were 40% lower compared with PD, and in multivariable analyses independently associated with microvessel density. In contrast, peritoneal mesothelial denudation, submesothelial thickness and fibrin abundance, number of activated, submesothelial fibroblasts and of mesothelial-mesenchymal transitioned cells were similar after KTx. Diffuse peritoneal podoplanin positivity was present in 40% of the transplanted patients. In subgroups matched for age, PD vintage, dialytic glucose exposure and peritonitis incidence, submesothelial hypoxia-inducible factor 1-alpha abundance and angiopoietin 1/2 ratio were lower after KTx, reflecting vessel maturation, while arteriolar and microvessel p16 and cleaved Casp3 were higher. Submesothelial mast cell count and interleukin-6 were lower, whereas transforming growth factor-beta induced pSMAD2/3 was similar as compared with children on PD. CONCLUSIONS: Peritoneal membrane damage induced with chronic administration of low-GDP PD fluids was less severe after KTx. While peritoneal microvessel density, primarily defining PD transport and ultrafiltration capacity, was normal after KTx and peritoneal inflammation less pronounced, diffuse podoplanin positivity and profibrotic activity were prevalent.

• Klíčová slova
• chronic kidney disease, kidney transplantation, pediatric, peritoneal dialysis, peritoneal membrane,
• MeSH
• chronické selhání ledvin * chirurgie   metabolismus   MeSH
• dialýza ledvin MeSH
• dialyzační roztoky metabolismus   MeSH
• dítě MeSH
• glukosa metabolismus   MeSH
• lidé MeSH
• peritoneální dialýza * škodlivé účinky   MeSH
• peritoneum metabolismus   MeSH
• peritonitida * metabolismus   MeSH
• transplantace ledvin * škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• dialyzační roztoky MeSH
• glukosa MeSH

In order to deliver a specific dialysis dose (Kt/V) to all patients, their product Kt (urea clearance K multiplied by dialysis time t) should be individually adjusted according to total body water (V) of each patient. With dialysis time being fixed in most centres for organisational reasons, such individualization can be accomplished by individually set blood flow (QB). For a given t, the value of QB also defines the magnitude of the cumulative blood volume (VB = QB*t), i.e. the volume of blood perfused through the dialyser during the whole dialysis time. VB is displayed by every contemporary dialysis machine but not used. The aim of this work was to derive an easy to use approach to QB individualization based on patient's body weight and dialysis time to obtain a desired Kt/V value which would also be easy to check after dialysis by looking at the obtained VB value. Statistically significant correlation was found between the QB-based Kt/V estimation and Kt/V determined by the other two methods demonstrating practical feasibility of the novel approach. Kt/V values obtained with the QB prescribed according to patient's body weight tended to be better in females and patients with higher body mass index.

• MeSH
• časové faktory MeSH
• dialýza ledvin metody   MeSH
• hemodialyzační roztoky MeSH
• index tělesné hmotnosti MeSH
• krevní objem MeSH
• lidé středního věku MeSH
• lidé MeSH
• lineární modely MeSH
• močovina metabolismus   MeSH
• monitorování fyziologických funkcí metody   normy   MeSH
• plánování péče o pacienty MeSH
• renální insuficience metabolismus   terapie   MeSH
• rychlost toku krve MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• tělesná hmotnost MeSH
• tělesná konstituce MeSH
• tělesná voda * MeSH
• tělesná výška MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH
• klinické zkoušky MeSH
• validační studie MeSH
• Názvy látek
• hemodialyzační roztoky MeSH
• močovina MeSH