Quality of care and monitoring in paediatric end stage renal disease

In this thesis quality of care and monitoring of chronic kidney disease - mineral bone disorder (CKD-MBD) and cardiovascular disease (CVD) is assessed. Practices and policies with regards to transplantation, growth hormone and hypertension are inventories and compared with current guidelines and literature. Since end stage renal disease (ESRD) in childhood is rare, large scale studies are scarce. Differences in policies might be caused by a lack of evidence based guidelines, possibly affecting health outcome. More research on the outcome of children with end stage renal disease seems warranted in order to produce uniform guidelines enabling the same treatment and outcome for each child, independently of where the child is being treated. Next, current methods of imaging of CKD-MBD and CVD are evaluated. Dual Energy X-ray Absorptiometry (DXA) seems unreliable for detecting and predicting CKD-MBD in patients with childhood onset ESRD. Children with ESRD show an impaired function of the left ventricle measured with Speckle Tracking Echocardiography (STE), without abnormal function as assessed with conventional echocardiography, showing that STE could be a reliable method to detect CVD. Finally, the effect of a quality improvement collaborative on quality of care (QOC) is assessed. A ceiling might have been reached with regards to QOC. This is possibly due to the fact that certain factors are present which cannot be influenced by the doctors or nurses.