NDT Advance Access published online on January 10, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm883
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The basic needs of children on haemodialysis in Turkey
Department of Pediatric Nephrology, K
rkkale University Medical School, Krkkale, Turkey
Correspondence and offprint requests to: Cüneyt Ensari, Konutkent 2, B4-C2, Cayyolu 06100, Ankara, Turkey. Tel: +90-312-2411223; Fax: +90-312-3106370; E-mail: cuneytensari{at}yahoo.co.uk
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Abstract |
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Background. Haemodialysis treatment can be very tiring and unpleasant, particularly for paediatric patients, families and also for the treatment team. In this study, the basic needs of children on haemodialysis were determined in order to improve the conditions of their therapy environment.
Methods. The requirements of 20 children and 40 adults, who were on haemodialysis therapy for a minimum of five sessions, were recorded by means of a questionnaire.
Results. The majority of children and adults preferred to be treated in separate units. All children and adults stated that they needed a constant transportation facility to be provided by the dialysis unit. All children wanted their parents/relatives to be with them during the dialysis sessions while only a minority of adults required an accompanying relative. The majority of both paediatric and adult patients preferred daytime sessions. The majority of children preferred to have the same nurse to needle their fistula and supervise their therapy session.
Conclusions. The health authority should recognize the role of the therapy team, including a paediatric nephrologist, in providen for the basic needs and fulfilling the expectations of paediatric haemodialysis patients in order to increase the efficiency of the treatment.
Keywords: children; haemodialysis; patient care
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Introduction |
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In several countries, paediatric patients are usually being admitted into adult haemodialysis units. This is mainly due to the fact that a separate unit for children would be costly even for developed countries [1–3]. In Turkey, health authorities design dialysis curricula in that the presence of consultant paediatric nephrologists or dialysis-certified paediatricians is not obligatory when there are <10 children in the adult unit [4]. Medical teams in adult units that are not organized for paediatric patients are usually overloaded with medical problems of haemodialysis patients and there is less concern for the basic emotional and social needs of these patients.
In this study, it was therefore intended to determine the expectations of paediatric and adult patients from the haemodialysis unit and the staff.
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Subjects and methods |
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A simple questionnaire was prepared in view of the data collected via personal communications with paediatric haemodialysis patients treated in the adult haemodialysis unit of Emergency Hospital and Atatürk Research Hospital, Ankara, Turkey. In order to avoid any bias, the questionnaire was not administered just by reading it to the patient, but, instead, following a friendly conversation with paediatric and adult patients, the questionnaires were filled out by the paediatric nephrologist responsible from the unit. At the time when the study was started, the doctor and patients had already built a close relationship that increased the reliability of the data obtained by the questionnaire.
There were 20 children (11 boys, 9 girls), including 12 of primary school age and 8 of secondary school age with an age range of 6 to 18 years (mean age: 12.5 years), and 40 adults (18 males, 22 females) aged between 20 and 82 years (mean age: 52 years) receiving haemodialysis therapy for a minimum of five haemodialysis sessions. An informed consent was taken from the parents of the paediatric patients and from adult patients, included in the study.
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Results |
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Fifteen (75%) paediatric patients, 12 of whom were of primary and 3 were at secondary school age, preferred to be treated in a separate paediatric haemodialysis unit or in a separate room in an adult unit while 32 (85%) of the 40 adult patients stated that they preferred not to be treated with paediatric patients. All children and adults stated that they needed a constant transportation facility provided by the dialysis unit since they all lived at long distances from the unit. Six (30%) children were willing to go to school whereas 14 (70%) were not. Seventeen (85%) children wanted their parents/relatives to be with them during the dialysis sessions while only 10% of adults required an accompanying relative. The majority of both paediatric (85%) and adult patients (90%) preferred daytime dialysis sessions. Sixteen (80%) paediatric patients (10 children of primary school age and 6 of secondary school age) preferred to have the same nurse to needle their fistula and also to supervise their therapy in each dialysis session whereas 45% of adult patients had such a preference. A total of 12 (60%) children comprising 6 of primary and 6 of secondary school age and 20 adults (50%) wanted to have dialysis from the same dialysis machine for each dialysis session.
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Discussion |
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Caring for children is different from adult patient care in haemodialysis therapy [2,5,6]. As emphasized in the recent guidelines published by the European Paediatric Dialysis Working Group [5], paediatric haemodialysis should be delivered in a paediatric dialysis unit. In Turkey, according to the current registry published in 2005 [7], nearly 500 regular haemodialysis patients under the age of 18 years have been reported. Most of them have been treated in private adult haemodialysis units after initial diagnosis. Fortunately, the costs of dialysis therapy, either in state hospitals or in private units, are covered by the Turkish government when the patient has social security. However, despite the increase in the number of both paediatric patients requiring haemodialysis and paediatric nephrologists, especially in highly populated areas, the need for separate paediatric haemodialysis units and the role of paediatric nephrologists were still not recognized in the recent national dialysis curriculum [4]. The results of our study showed that, not surprisingly, both paediatric patients, particularly those of primary school age, and adult patients preferred to be treated in separate units.
Paediatric patients require intense psychological, emotional, social and academic support that may also have positive impact both on their adherence and response to therapy [6,8]. It is essential to establish a child-friendly environment in the dialysis unit with interactions between children, family members and staff [2]. The results of our study are clearly in parallel with these views as the sick children included in the present study also complained of lack of social and psychological support such as the absence of their parents or relatives. An interesting finding was their unwillingness for school attendance that may also reflect their depressed psychological status due to their chronic illness. Though one of the reasons for establishing a separate paediatric unit should be to provide educational support, no dialysis unit has such support for paediatric patients in Turkey. Efforts to improve the condition of haemodialysis units, with respect to the expectations of the patients, will also improve their state of well-being. These efforts will help the families, as well as the therapy team, to deal with problems and decrease anxiety.
Ideally, paediatric haemodialysis units should be separated from adult units and, more importantly, paediatric haemodialysis should be performed under the supervision of a paediatric nephrologist, irrespective of the number of the patients or the condition of the unit. In the absence of a paediatric nephrologist or a dialysis-certified paediatrician in the area where the dialysis unit is set up, regular consultations with paediatric nephrologists or dialysis-certified paediatricians from the nearest region should be performed.
As a paediatric nephrologist, I do, therefore, hope that the significance of paediatric nephrologists in the management and well-being of paediatric dialysis patients will be recognized more by the health authorities in the future.
Conflict of interest statement. I declare that the results presented in this paper have not been published previously in whole or part.
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References |
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- Elpers L, McPhee D. Are we providing optimal pediatric patient care in hemodialysis? It is a dilemma, but children can receive care in an adult dialysis unit. Nephrol Nurs J (2004) 31:689.[Medline]
- Gilman C. Are we providing optimal pediatric patient care in hemodialysis? It's better to hemodialyze children in a pediatric dialysis unit. Nephrol Nurs J (2004) 31:690.
- Ehrich JH, El Gendi AA, Drukker A, et al. Demography of pediatric renal care in Europe: organization and delivery. Nephrol Dial Transplant (2005) 20:297–305.
[Abstract/Free Full Text] - National Curriculum for Dialysis Centers. (2005) Published by The Republic of Turkey, Ministry of Health.
- Fischbach M, Edefonti A, Schröder C, et al. Hemodialysis in children: general practical guidelines. Pediatr Nephrol (2005) 20:1054–1066.[CrossRef][Web of Science][Medline]
- Warady BA, Alexander SR, Watkins S, et al. Optimal care of the pediatric end stage renal disease patient on dialysis. Am J Kidney Dis (1999) 33:567–583.[Web of Science][Medline]
- Central Registry Committee. (2005) Registry of the Nephrology, Dialysis and Transplantation in Turkey. Published by The Turkish Society of Nephrology.
- Fukunishi I, Honda M. School adjustment of children with end-stage renal disease. Pediatr Nephrol (1995) 9:553–557.[CrossRef][Web of Science][Medline]
Accepted in revised form: 21.11.07
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