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Pediatric to Adult Nephrology Transition in CKD
Vivian Shi1, Alex Jang2, Hillary Copp2
1Division of Nephrology, Department of Medicine and Pediatrics, Stanford University, Palo Alto, California.
Insights
Pediatric chronic kidney disease (CKD) presents unique challenges during care transitions. This review identifies best practices for transferring young patients with CKD to adult specialists, ensuring continuity of care.
Area of Science:
- Nephrology
- Pediatric Medicine
- Healthcare Management
Background:
- Chronic kidney disease (CKD) affects 10% of the population, with some cases originating in childhood.
- Pediatric CKD is often asymptomatic, making incidence estimation difficult due to lack of routine screening.
- Advancements in healthcare increase the number of children with CKD requiring transfer to adult care.
Purpose of the Study:
- To summarize challenges in transitioning pediatric CKD patients to adult care.
- To highlight differences between pediatric and adult CKD care practices.
- To identify best practices for seamless care transfer.
Main Methods:
- Review of practitioner-related challenges.
- Analysis of patient-related challenges.
- Examination of unique healthcare needs during transfer.
- Overview of common pediatric CKD causes (e.g., congenital abnormalities).
Main Results:
- Challenges exist for both practitioners and patients during care transition.
- Pediatric and adult CKD care practices differ significantly.
- Specific considerations are needed for conditions like congenital abnormalities of the kidney and urinary tract.
Conclusions:
- Effective transition and transfer of care are crucial for pediatric CKD patients.
- Addressing practitioner and patient barriers can improve outcomes.
- Standardized best practices are needed to manage the growing population of young adults with CKD.
Abstract:
CKD affects roughly 10% of the general population. Some adults with CKD were diagnosed with their condition during childhood. Because early CKD is often asymptomatic, obtaining reliable estimates of the true incidence of pediatric CKD (onset before age 18 years) is difficult due to the lack of routine screening for disease in children. With advancements in health care ( e.g ., antenatal imaging and genetic testing) and improved survival outcomes for premature infants and children with complex care needs, a growing number of children with CKD will eventually transfer their care to adult specialists. The purpose of this review is to provide a practical summary of the challenges in the transition and transfer of care process for patients with nondialysis requiring CKD, highlight differences in pediatric and adult care practices based on our experiences, and identify best practices. We will review both practitioner-related and patient-related challenges, as well as the unique health care needs of children with CKD during the transfer of care. We will also provide an overview of the transition and transfer of care for common causes of CKD in children that are less common in adults, such as congenital abnormalities of the kidney and urinary tract.
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