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

Abstract

Background: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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."