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Predictors of failure to transition from pediatric to adult nephrology care
Laura Nishi1, Jay Kang2, Cybele Ghossein3
1Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. lnishi@nm.org.
Insights
Successful chronic kidney disease care transitions are vital. This study identified factors like higher kidney function, lack of insurance, and hypertension diagnosis as risks for unsuccessful transition to adult nephrology care.
Area of Science:
- Nephrology
- Pediatric to Adult Care Transition
- Chronic Kidney Disease Management
Background:
- Rising prevalence of chronic kidney disease (CKD) in young adults necessitates improved pediatric to adult care transition.
- High rates of unsuccessful transitions pose significant risks during this vulnerable life stage.
- Evidence-based transition protocols are crucial for facilitating successful care transfers.
Purpose of the Study:
- To evaluate the success of a dedicated nephrology transition clinic.
- To identify factors associated with failure to transition from pediatric to adult care.
- To inform resource allocation for high-risk CKD patients.
Main Methods:
- Retrospective chart review of patients in a joint nephrology transition clinic (2014-2022).
- Collected demographic and clinical data including diagnosis, socioeconomic factors, insurance, and kidney function.
- Analyzed data to identify predictors of successful versus failed transition and need for intervention.
Main Results:
- 92% of patients achieved successful transition to adult care.
- Higher kidney function (eGFR 116 vs 89 mL/min/1.73 m²), lack of insurance (15% vs 1%), and hypertension diagnosis (39% vs 9%) were linked to transition failure.
- Patients requiring prompts had higher pediatric no-show rates (10% vs 6%).
Conclusions:
- Nephrology transition clinics significantly improve patient outcomes.
- Key predictors of transition failure include higher kidney function, lack of insurance, and hypertension.
- Early identification and intervention are crucial for high-risk CKD patients during care transitions.
Background:
The increased prevalence and life expectancy of young adults with chronic kidney disease has led to a greater need to transition patients from pediatric to adult nephrology care. This care transition occurs at a highly vulnerable time in life, and rates of unsuccessful transition are high. Evidence-based transition protocols can greatly facilitate the process. Accordingly, Northwestern Medicine (NM) partnered with Lurie Children's Hospital (LCH) in 2014 to develop a nephrology transition clinic to help support these high-risk patients. To best allocate resources, it is important to identify those young adults most vulnerable to drop out. Here we report on the success of our clinic and factors affecting failure to transition.
Methods:
This was a retrospective chart review of patients seen in the NM/LCH transition clinic from 2014 to 2022. Demographic and clinical data of diagnosis, zip code, distance from clinic, average household income, parental/caregiver presence, working/school status, no-show rate, insurance, and baseline kidney function were collected. For those who successfully transitioned, data on prompt communications were also collected.
Results:
Overall, 92% of patients successfully transitioned to adult care. 27% of patients missed their first adult center appointment and required execution of a prompt protocol. After this intervention, an additional 19% of patients successfully transitioned. 39% of those who failed to transition had a primary diagnosis of hypertension as compared to only 9% in those who transitioned successfully. Those who successfully transitioned had a lower mean estimated glomerular filtration rate of 89 mL/min/1.73 m² as compared to 116 mL/min/1.73 m² in the group who failed to transition. 15% of those who failed to transition lacked insurance as compared to only 1% of patients who successfully transitioned. Finally, those who required prompts had a significantly higher no-show rate at the pediatric center at 10% as compared to 6% in those not requiring prompts.
Conclusion:
Transition clinics can help promote the successful transition from pediatric to adult nephrology care. Higher kidney function, lack of insurance, and primary diagnosis of hypertension were significantly correlated with failure to transition, and a higher pediatric center no-show rate was significantly correlated with the need for prompts in this single-center study.
Clinical Trial Number:
Not applicable.
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