Safely Transitioning Patients in Nephrology

Purpose In this review, we outline the guiding principles of safe and effective healthcare transition in adolescents and young adults (AYA) with kidney disease. We describe the inherent challenges associated with the process and review the available literature and resources that may support the healthcare team in achieving successful and safe transition. Recent Findings Safely guiding patients and families through the transition from pediatric to adult care is an important responsibility of the pediatric healthcare team. Growing evidence shows that lack of transition readiness increases morbidity and mortality in patients with chronic kidney disease and reduces allograft survival in transplanted AYA. Multidisciplinary efforts from multiple pediatric groups have developed evidence-based tools to holistically assess transition readiness and implement healthcare transition programs. Summary Increasing numbers of children with kidney disease are under the care of specialist pediatricians and pediatric nephrologists. Advancing diagnostics, medical management, and access to kidney replacement therapies—including both dialysis and transplantation—have steadily improved outcomes for these children. Thankfully, many are surviving childhood and adolescence and ultimately require transition to adult services. Without proper preparation for a successful healthcare transition, AYAs are at particularly high risk for poor health outcomes during this time. Growing evidence supports early, multi-disciplinary evaluation of patients and their families to inform the development of individualized transition programs which consider all aspects of this complex process. Herein, we compile the available evidence relating to best practice for healthcare transition and review available tools and strategies to promote better outcomes in this vulnerable AYA group.