Adolescent dialysis patient transition to adult care: a cross-sectional survey

Abstract

Adolescent dialysis patients transitioning to adult care are particularly vulnerable, dependent on complex, demanding and life-sustaining treatment. There is little published information on transition practices for this group. Therefore, a survey was carried out to assess the current status. Results are presented for 58 paediatric dialysis centres in North America and Europe. The majority of centres (53%) did not have a fixed cut-off age for transfer. For those that did, it ranged from 17 to 22 years, with the median 20.5 years and mean [+/- standard deviation (SD)] of 19.9 (+/-1.5) years. Only one third of centres reported a transition programme. Less than 20% of young adult patients were perceived to function autonomously at transfer. The paediatric centres had minimal knowledge of resources at the adult receiving sites. For the majority of programs there was a system in place to assist with application for social and health benefits (83%), an adult dialysis unit linked to the paediatric programme (62%) and an opportunity for patients to choose (78%) and visit (83%) the adult unit prior to transfer. Seventy-four percent of centres without a transition programme believed there was a need for one. This is an area clearly in need of attention.

Behavioral disorders and low quality of life in children and adolescents with chronic kidney disease

“…Our findings are yet another step to providing the medical professionals assisting these patients with the clinical support to identify and treat the psychosocial barriers and to promote better clinical control and a better QOL in this population. Moreover, we believe that our findings focus attention on the need for a multidisciplinary team approach to pediatric CKD, since the proper care of these patients clearly involves challenging issues, such as dealing with complex clinical, nutritional, and emotional disorders [53][54][55][56][57]. Prospective multicenter studies are still needed in order to identify predictors of the QOL of children and adolescents with CKD.…”

Transition from pediatric to adult care after solid organ transplantation

“…Saudi Arabia and Jamaica) to as long as the person has funding to stay. In the survey of pediatric dialysis centers, 53% had no fixed cut-off age [28].…”

“…The timing of transfer is even more controversial [1], and Bell [28] has called for professionals to lobby for developmentally appropriate flexible discharge criteria. Age of transfer is often linked to institutional rules, rather than an objective assessment of transfer readiness, and can range from 12 years of age (e.g.…”

Comparative clinical outcomes between pediatric and young adult dialysis patients

“…Although the process of transition is the subject of increasing attention, transition practices are not standardized across centers. In a recent survey of transition practices in 58 pediatric dialysis centers in North America and Europe, only one-third of centers reported having a formal transition program in place, and less than 20% of young adult patients were perceived as functioning autonomously at the time of their transfer to adult care [19].…”

“…In most dialysis settings, the transition occurs between the ages of 17 and 22 years [19]. Unfortunately, this process is not always successful, and most pediatric nephrologists can identify individual adolescent patients whose transition to adult care was associated with significant morbidity.…”