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

Tasic VeliborMedical School, University Children’s Hospital, North MacedoniaEdvardsson Vidar O.Iceland Children’s Medical Center, Landspitali – The National University Hospital of Iceland, IcelandPreka EvgeniaPaediatric Nephrology, United KingdomPrikhodina LarisResearch and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, RussiaStefanidis Constantinos J.Department of Pediatric Nephrology, “Mitera” Children’s Hospital, GreeceTopaloglu RezanDepartment of Pediatric Nephrology, Hacettepe University School of Medicine, TurkeyShtiza DiamantDepartment of Pediatric Nephrology, University Hospital Centre “Mother Teresa”, AlbaniaSarkissian AshotArabkir Joint Medical Centre, Yerevan State Medical University, ArmeniaMueller-Sacherer ThomasDepartment of Pediatric Nephrology and Gastroenterology, AustriaFataliyeva RenaDepartment of Pediatric Nephrology, Children’s Hospital, AzerbaijanKazyra Ina1st Department of Pediatrics, Belarusian State Medical University, BelarusLevtchenko ElenaDepartment of Pediatrics & Division of Pediatric Nephrology, University Hospitals Leuven, BelgiumDanka PokrajacDepartment of Pediatric Nephrology, University Children’s Hospital, Bosnia and HerzegovinaRoussinov DimitarNephrology and Hemodialysis Clinic, University of Sofia, Sofia, BulgariaMilošević DankoPediatric Clinic, University Hospital Center Zagreb, CroatiaElia AvraamDepartment of Paediatrics, Archbishop Makarios III Hospital, CyprusSeeman TomasDepartment of Pediatrics, 2nd Medical Faculty, Charles University Prague, Czech RepublicFaerch MiaDepartment of Pediatrics and Adolescent Medicine, Aarhus University Hospital, DenmarkVainumae IngaDepartment of Pediatrics, University of Tartu, EstoniaKataja JanneDepartment of Paediatrics and Adolescents Medicine, Turku University Hospital, FinlandTsimaratos MichelDepartment of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique des Hôpitaux de Marseille, FranceRtskhiladze IrakliDepartment of Pediatrics, Medical Centre Mrcheveli, GeorgiaHoyer Peter F.Department of Pediatric Nephrology, University Hospital Essen, Essen, GermanyReusz GeorgeFirst Department of Pediatrics, Semmelweis University, HungaryAwan AtifDepartment for Paediatric Nephrology & Transplantation, Children's Health Ireland, IrelandLotan DannyDivision of Pediatric Nephrology, Sheba Medical Center, Edmond and Lily Children’s Hospital, IsraelPeruzzi LiciaNigmatullina NazimDepartment of Nephrology, Kazakh National Medical University, KazakhstanBeishebaeva NasiraDepartment of Nephrology, National Center of Maternity and Childhood Welfare under the Ministry of Health of the Kyrgyz Republic, KyrgyzstanJeruma EditeBērnu Slimību Klīnika, Nefroloģijas Profila Virsārste, LatviaJankauskiene AugustinaPediatric Center, Institute of Clinical Medicine, Vilnius University, LithuaniaNiel OlivierPediatric Nephrology Unit, Department of Pediatrics, Centre Hospitalier de Luxembourg, LuxemburgSaid-Conti ValerieDepartment of Child and Adolescent Health, Mater Dei Hospital, MaltaCiuntu AngelaNephrology Unit, National Institute of Health Care for Mother and Child, MoldovaPavićević SnežanaClinical Center of Montenegro, Institute for Sick Children, MontenegroOosterveld MichielDepartment of Paediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, NetherlandsBjerre AnnaDepartment of Pediatric and Adolescent Medicine, University Hospital of Oslo, NorwayTkaczyk MarcinDepartment of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, PolandTeixeira AnaPediatric Nephrology Division, Centro Hospitalar Universitário do Porto, PortugalLungu Adrian C.Pediatric Nephrology, Fundeni Clincal Institute, RomaniaTsygin AlexeyNational Medical and Research Centre for Children's Health, RussiaStojanović VesnaPediatric Intensive Care Unit, Institute for Child and Youth Health Care of Vojvodina, SerbiaPodracka LudmilaDepartment of Pediatrics, Comenius University, SlovakiaKersnik Levart TanjaPediatric Nephrology Department, Children’s Hospital, University Medical Centre Ljubljana, SloveniaEspino-Hernández MarPediatric Nephrology, Pediatrics, University Hospital 12 Octubre, SpainBrandström PerPediatric Uro-Nephrologic Center, Department of Pediatrics Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, SwedenSparta GiuseppinaDepartment of Pediatric Nephrology, University Children’s Hospital, SwitzerlandAlpay HarikaDivision of Pediatric Nephrology, Marmara University, TurkeyIvanov DmytroNephrology and RRT Department, Shupyk National Healthcare University of Ukraine, UkraineDudley JanDepartment of Paediatric Nephrology, Bristol Children's Hospital, United KingdomKhamzaev KomiljonDepartment of Pediatric Nephrology and Hemodialysis, Tashkent Pediatric Medical Institute, National Children's Medical Center, UzbekistanHaffner DieterChildren’s Hospital, Hannover Medical School, GermanyEhrich JochenChildren’s Hospital, Hannover Medical School, Germany

2025en

ABI

Abstract

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 Children's 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.

Identifiers

DOI: 10.3389/fped.2024.1327422/full

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