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Moving on: transitioning young people with chronic kidney disease to adult care

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Abstract

Advances in the care of children mean that adolescents with chronic kidney disease (CKD) are surviving to adulthood and requiring transition to adult care. The transition phase is well-recognised to be associated with considerable excess morbidity and graft loss, but these outcomes may be avoidable through a structured transition programme. This review will discuss the (1) challenges encountered by patients with CKD, caregivers and clinicians during transition; (2) predictors and outcomes of transition; (3) current guidelines on transition from paediatric to adult renal services; (4) interventions and research directions that may help to improve the care and outcomes for young people with CKD in transition. In spite of the substantial improvement in health gains required for this disadvantaged population, there is to date only limited evidence on the effects of current transition programmes.

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Authors and Affiliations

  1. Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia

    Anna Francis, Jonathan C. Craig & Germaine Wong

  2. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia

    David W. Johnson

  3. Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia

    David W. Johnson

  4. Translational Research Institute, Brisbane, Australia

    David W. Johnson

Authors
  1. Anna Francis
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  2. David W. Johnson
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  3. Jonathan C. Craig
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  4. Germaine Wong
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Correspondence to Anna Francis.

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Additional information

Answers: 1. d; 2. a; 3. 3; 4. e; 5. a

Summary points

• Transition is not as a single event in time, but rather a well-planned process that occurs over time, involving the transfer of care from the paediatric health service to the adult health service.

• The complex burden of chronic kidney disease (CKD) is challenging for young people, especially as they negotiate the transfer from paediatric to adult care and contend with their own maturation. This may be exacerbated by concomitant developmental delay with substantial variability in the transitional requirements among young people with CKD, and in some the need for longer-term transitional support in the adult care facility until they are able to function unsupported.”

• Transition may be associated with poor medical outcomes, including reduced medication adherence, and those with kidney transplants may experience acute rejection and graft loss.

• Transition programmes involving a multi-disciplinary team appear to improve the outcomes post transition, but further research is needed.

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Francis, A., Johnson, D.W., Craig, J.C. et al. Moving on: transitioning young people with chronic kidney disease to adult care. Pediatr Nephrol 33, 973–983 (2018). https://doi.org/10.1007/s00467-017-3728-y

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  • DOI: https://doi.org/10.1007/s00467-017-3728-y

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