Transition from Paediatric to Adult Renal Care

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Transition from Paediatric to Adult Renal Care

• Alan R Watson and Mike Shooter

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TRANSFER

• This should take place at the end of a
• TRANSITION PROCESS
• and must be
• INDIVIDUALISED
• for each patient

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Issues to be Addressed

• Anxieties of the young person, family and adult
  nephrologist
• Issues of compliance
• Are self-management skills adequate?
• Is there long-term social support?

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Differences Between Paediatric and Adult Units
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Joe Aged 18 years 3 months

• Chronic renal failure since birth due to
  posterior urethral valves
• Multiple operations with vesicostomy for 6
  months, left ureterostomy for 12 months,
  peritoneal dialysis catheter and gastrostomy aged
  8
• Renal transplant aged 10
• Recurrent UTIs and creation of Mitrofanoff to
  allow intermittent catheterisation 9 months
  post-transplant
• Loss of transplant due to suspected
  non-compliance aged 14 years of age
• Haemodialysis with internal jugular venous
  catheter
• LRD from mother 15½ years of age
• Recent rise in creatinine with variable
  Tacrolimus levels

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• Current medication
• Tacrolimus 2mg bd
• Mycophenolate mofetil 500mg bd
• Prednisolone 5mg alternate days
• Atenolol 100mg daily
• Nifedipine long-acting 60mg daily
• Calcium carbonate 600mg tds with food
• Alfacalcidol 500ng daily

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Social History

• Joe has a brother aged 21 who is at university
• Father left home one year after first transplant
  and has very little contact with Joe. Mother has
  new partner.
• Mother usually drives Joe to clinic appointments
• Joe behind in schoolwork but hopes to go to
  college to do computing
• Attended hospital youth club on one occasion but
  hasnt attended transition workshop or holiday
  group
• Gets on well with staff in paediatric unit

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Transition Clinic

• Joe
• His mother
• Paediatric nephrologist, Dr Brown
• Adult nephrologist, Dr Jones

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• Transfer is an event
• Transition is a process
• Patient, family, paediatric and adult staff must
  all engage with the issues
• ________________________________
• Watson AR, Shooter M. Transition of adolescents
  from paediatric to adult dialysis units. Adv
  Perit Dial 199612176-178
• Watson AR. Problems and pitfalls of transition
  from paediatric to adult renal care. Pediatr
  Nephrol 200520113-117
• Watson AR. Hospital youth work and adolescent
  support. Arch Dis Child 200489440-442