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Adherence to transition guidelines in European paediatric nephrology units

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Abstract

Background

There is increasing focus on the problems involved in the transition and transfer of young adult patients from paediatric to adult renal units. This situation was addressed by the 2011 International Pediatric Nephrology Association/International Society of Nephrology (IPNA/ISN) Consensus Statement on transition.

Methods

We performed a survey of transition practices of 15 paediatric nephrology units across Europe 2 years after publication of the consensus statement.

Results

Two thirds of units were aware of the guidelines, and one third had integrated them into their transition practice. Forty-seven per cent of units transfer five or fewer patients with chronic kidney disease (CKD) stage 5 per year to a median of five adult centres, with higher numbers of CKD stages 2–4 patients. Seventy-three per cent of units were required by the hospital or government to transfer patients by a certain age. Eighty per cent of units commenced transition planning after the patient turned 15 years of age and usually within 1–2 years of the compulsory transfer age. Forty-seven per cent of units used a transition or transfer clinic. Prominent barriers to effective transition were patient and parent attachment to the paediatric unit and difficulty in allowing the young person to perform self-care.

Conclusions

Whereas awareness of the consensus statement is suboptimal, it has had some impact on practice. Adult nephrologists receive transferred patients infrequently, and the process of transition is introduced too late by paediatricians. Government- and hospital-driven age-based transfer policies distract focus from the achievement of competencies in self care. Variable use of transition clinics, written patient information and support groups is probably due to economic and human-resource limitations. The consensus statement provides a standard for evolving and evaluating transition policies jointly agreed upon by paediatric and adult units.

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Abbreviations

CKD:

Chronic kidney disease

IPNA:

International Pediatric Nephrology Association

ISN:

International Society of Nephrology

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Author information

Authors and Affiliations

  1. Nottingham Children’s Hospital, Children’s Renal and Urology Unit, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK

    Thomas A. Forbes & Alan R. Watson

  2. Gdansk University Hospital Medical School, Gdansk, Poland

    Aleksandra Zurowska

  3. Great Ormond Street Hospital for Children, London, UK

    Rukshana Shroff

  4. Gazi University Hospital, Gazi, Turkey

    Sevcan Bakkaloglu

  5. University Hospital Motol, Prague, Czech Republic

    Karel Vondrak

  6. Hospital Hautepierre, Strasbourg, France

    Michel Fischbach

  7. University Hospital, Ghent, Belgium

    Johan Van de Walle

  8. Hospital Cruces, Barakaldo, Vizcaya, Spain

    Gema Ariceta

  9. Fondazione IRCCS Policlinico, Pediatrica DeMarchi, Milan, Italy

    Alberto Edefonti

  10. University Hospital for Pediatrics, Vienna, Austria

    Christoph Aufricht

  11. Vilnius University Children’s Hospital, Vilnius, Lithuania

    Augustina Jankauskiene

  12. University of Helsinki, Helsinki, Finland

    Tuula Holta

  13. Ankara University Hospital, Ankara, Turkey

    Mesiha Ekim

  14. Centre for Paediatric and Adolescent Medicine, Heidelberg, Germany

    Claus Peter Schmitt

  15. Children’s Hospital, A & P Kyriakou, Athens, Greece

    Constantinos Stefanidis

Authors
  1. Thomas A. Forbes
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  2. Alan R. Watson
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  3. Aleksandra Zurowska
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  4. Rukshana Shroff
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  13. Tuula Holta
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  14. Mesiha Ekim
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  15. Claus Peter Schmitt
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  16. Constantinos Stefanidis
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Consortia

European Paediatric Dialysis Working Group

Corresponding author

Correspondence to Alan R. Watson.

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Forbes, T.A., Watson, A.R., Zurowska, A. et al. Adherence to transition guidelines in European paediatric nephrology units. Pediatr Nephrol 29, 1617–1624 (2014). https://doi.org/10.1007/s00467-014-2809-4

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  • DOI: https://doi.org/10.1007/s00467-014-2809-4

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