An Interdisciplinary Approach to Optimize the Care of Transitioning Adolescents and Young Adults with CKD

Abstract

Adolescents and young adults (AYAs) with CKD or end-stage kidney disease (ESKD) have unique medical, dental, psychosocial, neurocognitive, and academic needs and require close interdisciplinary collaboration to optimize their care. The etiology of CKD in AYAs is diverse compared to older adults. With their continuously improved survival, AYAs must start preparation for health-care transition (HCT) from pediatric- to adult-focused health care in the pediatric setting and it must continue at the adult-focused setting, given that their brain maturation and self-management skill acquisition occur until their mid-20s. While the growth and physical maturation of most visible body parts occur before 18 years of age, the prefrontal cortex of the brain, where reasoning, impulse control, and other higher executive functions reside, matures around 25 years of age. The HCT process must be monitored using patient- and caregiver-measuring tools to guide interventions. The HCT process becomes more complex when patients and/or caregivers have a language barrier, different cultural beliefs, or lower literacy levels. In this article, we discuss the unique comorbidities of pediatric-onset CKD/ESKD, provide information for a planned HCT preparation, and suggest interdisciplinary coordination as well as cultural and literacy-appropriate activities to achieve optimal patient outcomes.

Psychosocial supports within pediatric nephrology practices: A pediatric nephrology research consortium survey

“…While prior research has established that interdisciplinary care can vary widely across centers with variable team structure [ 42 ], results from our study may help define differences across centers by number of nephrology providers and patients served. The opportunity to collaborate within an interdisciplinary psychosocial provider team may help maximize best outcomes, such as improvement in medication adherence and preparation for patient transition to adulthood [ 43 ]. Leveraging the expertise of multiple psychosocial disciplines may help alleviate the burden of care that falls on a limited number of pediatric nephrology providers.…”

Transition of kidney care at 18: Challenges and practical solutions for India

“…Interrupted follow-up, difficulties in interdepartmental coordination, lack of supporting professionals, and different approaches to treatment in the pediatric and adult settings contribute to challenges faced by a pediatrician. [ 33 ]…”

23rd International Conference on Dialysis: Advances in Chronic Kidney Disease 2021 (April 20–23, 2021, USA)

“…If effective, the novel therapy may have the potential of delaying kidney function decline in CAKUT patients. Advancing healthcare transition to adulthood in adolescents with CKD and ESKD has been a topic of interest of Diaz-Gonzalez de Ferris et al [14] for many years. Their review provides a detailed account on the latest diverse approaches to accomplish optimal patient outcomes.…”