Clinical Outcomes of a Dedicated Kidney Adolescent and Young Adult Clinic (KAYAC) in South Africa

Abstract

Aim: Adolescents and young adults (AYAs) are increasingly utilising kidney health care services. However, there is no data on the impact of kidney transition clinics, as well as the AYA spectrum of kidney diseases, in South Africa (SA). This study evaluates kidney outcomes and patient survival amongst AYA patients attending a dedicated kidney AYA clinic (KAYAC).

Methods: This 5-year retrospective study included AYA (aged 13-25) with kidney disease, attending a tertiary nephrology service. A comparative analysis of outcomes between patients who attended the KAYAC and those attending the standard-of-care adult kidney clinics was performed. The primary composite outcome assessed included doubling of creatinine, reduction in eGFR > 40%, kidney failure, requirement for kidney replacement therapy, or death. Logistic regression evaluated the associations between relevant variables, death, and loss to follow-up (LTFU).

Results: The AYA cohort consisted of 292 patients: 111 (38.0%) attended KAYAC and 181 (62.0%) attended adult clinics. Glomerular diseases (72.6%), congenital urinary tract anomalies (10.6%) and hereditary conditions (8.2%) were the most common causes of kidney disease. The KAYAC group had delayed progression to kidney failure with an improved composite outcome (p = 0.018), lower mortality (p = 0.046) and less LTFU (p = 0.001). Both groups demonstrated high rates of non-adherence, with a prevalence of 33.9% in the total cohort.

Conclusion: AYA are a unique population who could benefit from KAYAC transition clinics. A dedicated KAYAC has been found to be associated with better kidney outcomes, lower mortality and less LTFU, underscoring its critical role in resource-limited settings.

Keywords: Adolescent and young adult; chronic kidney disease; kidney outcomes; transition clinic.

FIGURE 1

Kaplan–Meier Curve composite outcome* of patients attending the KAYAC and the kidney adult clinic (a), stratified by attendance and underlying aetiology (b). Kaplan–Meier Curve of patient survival in patients attending the kidney AYA clinic and the kidney adult clinics (c). AYA, adolescent and young adults; GN, glomerulonephritis. *Composite outcome: doubling of creatinine, reduction in eGFR > 40%, kidney failure, requirement of kidney replacement therapy or death. **p values reflect the comparison the two clinic attendance groups.