10 tips for a transition clinic from paediatric to adult nephrology

The transition from paediatric to adult renal care is a challenging time for children and young people (CYP). For them, this is a period of seismic change overall and a key step during their journey from parental support to independence. Improving outcomes in paediatric care is resulting in a growing population of CYP who require transition and individualised care planning. The point of transfer to adult services is also a risk escalator to long-term health and it is important to avoid disengagement. Awareness of neurodevelopmental biology and its effects on decision-making is a cornerstone to understanding the behaviour of CYP during this time. There is good evidence to suggest that a holistic approach to transition, rather than simply a formal transfer of care, improves patients' understanding and ability to self-care, and in so doing reduces morbidity and mortality. A coordinated process of transition involves empowerment and shared decision-making and starts in paediatric care aided by transition toolkits. In the absence of a structured transition, CYP often present to adult services unplanned and in a crisis situation. CYP presenting directly to adult services are a particularly vulnerable group with unmet needs due to missing out on a formal transition process. Local innovation, regional initiatives and national policy can help reduce variation and ensure access to good-quality transition care and clinics. Setting up such transition clinics requires careful planning, a multidisciplinary approach and adequate long-term funding. We provide a brief toolkit to set up, run and develop a structured transition service.