Diversity of kidney care referral pathways in national child health systems of 48 European countries

Tasic V. Edvardsson V.O. Preka E. Prikhodina L. Stefanidis C.J. Topaloglu R. Shtiza D. Sarkissian A. Mueller-Sacherer T. Fataliyeva R. Kazyra I. Levtchenko E. Pokrajac D. Roussinov D. Milošević D. Elia A. Seeman T. Faerch M. Vainumae I. Kataja J. Tsimaratos M. Rtskhiladze I. Hoyer P.F. Reusz G. Awan A. Lotan D. Peruzzi L. Nigmatullina N. Beishebaeva N. Jeruma E. Jankauskiene A. Niel O. Said-Conti V. Ciuntu A. Pavićević S. Oosterveld M. Bjerre A. Tkaczyk M. Teixeira A. Lungu A.C. Tsygin A. Stojanović V. Podracka L. Kersnik Levart T. Espino-Hernández M. Brandström P. Sparta G. Alpay H. Ivanov D. Dudley J. Khamzaev K. Haffner D. Ehrich J.
8 March 2024 Frontiers Media SA

Frontiers in Pediatrics
2024 #12

Background: Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. Methods: In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. Results: The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Childrens Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Conclusion: Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain. 2024 Tasic, Edvardsson, Preka, Prikhodina, Stefanidis, Topaloglu, Shtiza, Sarkissian, Mueller-Sacherer, Fataliyeva, Kazyra, Levtchenko, Pokrajac, Roussinov, Milošević, Elia, Seeman, Faerch, Vainumae, Kataja, Tsimaratos, Rtskhiladze, Hoyer, Reusz, Awan, Lotan, Peruzzi, Nigmatullina, Beishebaeva, Jeruma, Jankauskiene, Niel, Said-Conti, Ciuntu, Pavićević, Oosterveld, Bjerre, Tkaczyk, Teixeira, Lungu, Tsygin, Stojanović, Podracka, Kersnik Levart, Espino-Hernández, Brandström, Sparta, Alpay, Ivanov, Dudley, Khamzaev, Haffner and Ehrich.

acute kidney injury , healthcare services , nephrotic syndrome , pediatric nephrology , referral clinical pathways , urinary tract infections

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Medical School, University Children’s Hospital, Skopje, North Macedonia
Iceland Children’s Medical Center, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
Paediatric Nephrology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
Department of Pediatric Nephrology, “Mitera” Children’s Hospital, Athens, Greece
Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
Department of Pediatric Nephrology, University Hospital Centre “Mother Teresa”, Tirana, Albania
Arabkir Joint Medical Centre, Yerevan State Medical University, Yerevan, Armenia
Department of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
Department of Pediatric Nephrology, Children’s Hospital, Baku, Azerbaijan
1st Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
Department of Pediatrics & Division of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
Department of Pediatric Nephrology, University Children’s Hospital, Sarajevo, Bosnia and Herzegovina
Nephrology and Hemodialysis Clinic, University of Sofia, Sofia, Bulgaria
Pediatric Clinic, University Hospital Center Zagreb, Zagreb, Croatia
Department of Paediatrics, Archbishop Makarios III Hospital, Nicosia, Cyprus
Department of Pediatrics, 2nd Medical Faculty, Charles University Prague, Prague, Czech Republic
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Pediatrics, University of Tartu, Tartu, Estonia
Department of Paediatrics and Adolescents Medicine, Turku University Hospital, Turku, Finland
Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Department of Pediatrics, Medical Centre Mrcheveli, Tbilisi, Georgia
Department of Pediatric Nephrology, University Hospital Essen, Essen, Germany
First Department of Pediatrics, Semmelweis University, Budapest, Hungary
Department for Paediatric Nephrology & Transplantation, Childrens Health Ireland, Dublin, Ireland
Division of Pediatric Nephrology, Sheba Medical Center, Edmond and Lily Children’s Hospital, Tel Hashomer, Israel
Nephrology, Dialysis and Transplantation Unit, Regina Margherita University Childrens Hospital, Turin, Italy
Department of Nephrology, Kazakh National Medical University, Almaty, Kazakhstan
Department of Nephrology, National Center of Maternity and Childhood Welfare under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
Bērnu Slimību Klīnika, Nefroloģijas Profila Virsārste, Riga, Latvia
Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
Pediatric Nephrology Unit, Department of Pediatrics, Centre Hospitalier de Luxembourg, Luxemburg, Luxembourg
Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
Nephrology Unit, National Institute of Health Care for Mother and Child, Chisinau, Moldova
Clinical Center of Montenegro, Institute for Sick Children, Podgorica, Montenegro
Department of Paediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
Department of Pediatric and Adolescent Medicine, University Hospital of Oslo, Oslo, Norway
Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Pediatric Nephrology Division, Centro Hospitalar Universitário do Porto, Porto, Portugal
Pediatric Nephrology, Fundeni Clincal Institute, Bucharest, Romania
National Medical and Research Centre for Childrens Health, Moscow, Russian Federation
Pediatric Intensive Care Unit, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
Department of Pediatrics, Comenius University, Bratislava, Slovakia
Pediatric Nephrology Department, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
Pediatric Nephrology, Pediatrics, University Hospital 12 Octubre, Madrid, Spain
Pediatric Uro-Nephrologic Center, Department of Pediatrics Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Pediatric Nephrology, University Children’s Hospital, Zurich, Switzerland
Division of Pediatric Nephrology, Marmara University, Istanbul, Turkey
Nephrology and RRT Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
Department of Paediatric Nephrology, Bristol Childrens Hospital, Bristol, United Kingdom
Department of Pediatric Nephrology and Hemodialysis, Tashkent Pediatric Medical Institute, National Childrens Medical Center, Tashkent, Uzbekistan
Children’s Hospital, Hannover Medical School, Hannover, Germany

Medical School
Iceland Children’s Medical Center
Paediatric Nephrology
Research and Clinical Institute for Pediatrics
Department of Pediatric Nephrology
Department of Pediatric Nephrology
Department of Pediatric Nephrology
Arabkir Joint Medical Centre
Department of Pediatric Nephrology and Gastroenterology
Department of Pediatric Nephrology
1st Department of Pediatrics
Department of Pediatrics & Division of Pediatric Nephrology
Department of Pediatric Nephrology
Nephrology and Hemodialysis Clinic
Pediatric Clinic
Department of Paediatrics
Department of Pediatrics
Department of Pediatrics and Adolescent Medicine
Department of Pediatrics
Department of Paediatrics and Adolescents Medicine
Department of Multidisciplinary Pediatrics
Department of Pediatrics
Department of Pediatric Nephrology
First Department of Pediatrics
Department for Paediatric Nephrology & Transplantation
Division of Pediatric Nephrology
Nephrology
Department of Nephrology
Department of Nephrology
Bērnu Slimību Klīnika
Pediatric Center
Pediatric Nephrology Unit
Department of Child and Adolescent Health
Nephrology Unit
Clinical Center of Montenegro
Department of Paediatric Nephrology
Department of Pediatric and Adolescent Medicine
Department of Pediatrics
Pediatric Nephrology Division
Pediatric Nephrology
National Medical and Research Centre for Childrens Health
Pediatric Intensive Care Unit
Department of Pediatrics
Pediatric Nephrology Department
Pediatric Nephrology
Pediatric Uro-Nephrologic Center
Department of Pediatric Nephrology
Division of Pediatric Nephrology
Nephrology and RRT Department
Department of Paediatric Nephrology
Department of Pediatric Nephrology and Hemodialysis
Children’s Hospital

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