Transitioning from pediatric- to adult-focused dialysis care: A systematic review with recommendations

There is limited data evaluating the practices of nephrologists who prepare dialysis-dependent adolescents and young adults (AYA) for healthcare transition (HCT) from pediatric- to adult-focused healthcare. The aims of this manuscript are 1) critically evaluate the current evidence and experiences surrounding HCT from pediatric- to adult-focused dialysis units, 2) make recommendations that can be implemented for this process.

We searched PubMed, EMBASE, CINAHL, COCHRANE, and clinicaltrials.gov to identify studies that pertain to the HCT of AYA patients from pediatric- to adult-focused dialysis care.

A total of 14 studies were included and were grouped into subcategories to facilitate synthesis: HCT process, preparedness of patient and family, preparedness of adult-focused nephrology providers, barriers to HCT, and quality of life. These included studies highlight the importance of creating an HCT process with a formal policy. They focus upon the importance of patient and family preparedness and measuring HCT readiness using standardized scales. They underline the importance of identifying adult-focused nephrology "HCT champions" to care for AYA requiring dialysis. Lastly, they emphasize the importance of measuring quality of life in AYA patients to ensure optimal patient-centered HCT.

There is limited data on HCT for AYA with end-stage kidney disease. Upon review and analysis of current literature, we emphasize the importance of key fundamental pieces: the development of a transition policy, creating formal "HCT processes" including an assessment of readiness, and transferring care to adult-focused services."