Adherence to transition guidelines in European paediatric nephrology units.
BACKGROUND
There is increasing focus on the problems involved in the transition and transfer of young adult patients from paediatric to adult renal units. This situation was addressed by the 2011 International Pediatric Nephrology Association/International Society of Nephrology (IPNA/ISN) Consensus Statement on transition.


METHODS
We performed a survey of transition practices of 15 paediatric nephrology units across Europe 2 years after publication of the consensus statement.


RESULTS
Two thirds of units were aware of the guidelines, and one third had integrated them into their transition practice. Forty-seven per cent of units transfer five or fewer patients with chronic kidney disease (CKD) stage 5 per year to a median of five adult centres, with higher numbers of CKD stages 2-4 patients. Seventy-three per cent of units were required by the hospital or government to transfer patients by a certain age. Eighty per cent of units commenced transition planning after the patient turned 15 years of age and usually within 1-2 years of the compulsory transfer age. Forty-seven per cent of units used a transition or transfer clinic. Prominent barriers to effective transition were patient and parent attachment to the paediatric unit and difficulty in allowing the young person to perform self-care.


CONCLUSIONS
Whereas awareness of the consensus statement is suboptimal, it has had some impact on practice. Adult nephrologists receive transferred patients infrequently, and the process of transition is introduced too late by paediatricians. Government- and hospital-driven age-based transfer policies distract focus from the achievement of competencies in self care. Variable use of transition clinics, written patient information and support groups is probably due to economic and human-resource limitations. The consensus statement provides a standard for evolving and evaluating transition policies jointly agreed upon by paediatric and adult units.
Nottingham Children's Hospital, Children's Renal and Urology Unit, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK.
Thomas A
TA
Forbes
Alan R
AR
Watson
Aleksandra
A
Zurowska
Rukshana
R
Shroff
Sevcan
S
Bakkaloglu
Karel
K
Vondrak
Michel
M
Fischbach
Johan
J
Van de Walle
Gema
G
Ariceta
Alberto
A
Edefonti
Christoph
C
Aufricht
Augustina
A
Jankauskiene
Tuula
T
Holta
Mesiha
M
Ekim
Claus Peter
CP
Schmitt
Constantinos
C
Stefanidis
D000293:Adolescent; D000328:Adult; D002648:Child; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data*; D006757:Hospital Units / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009398:Nephrology / Q000592:standards*; D010360:Patient Transfer / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D055815:Young Adult