Improving outcomes for teenage dialysis patients

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The BC Children’s Hospital renal program launched a transition clinic in 2007, with the goal of increasing survival rates among adolescents transferring from pediatric to adult renal services.

Headed by pediatric   nephrologist Dr. Mina Matsuda-Abedini, a clinical investigator at the Child & Family Research Institute (CFRI) in Vancouver, the transition clinic team includes a renal nurse, youth health specialist, renal dietitian, renal pharmacist and social worker. The team provides patients and their families with a comprehensive circle of care during their transition from pediatric to adult renal care.

Results of a recent study indicate the clinic has accomplished its goal. In the study, led by Drs. Chanel Prestidge and Matsuda-Abedini, patient and kidney graft survival for pediatric renal transplant recipients who received care in the transition clinic were compared to the same measures for a cohort of pediatric transplant patients transferred to adult care prior to establishment of the clinic.

Dr. Matsuda-Abedini says of the research results, “Before the transition clinic, poor outcomes – defined in our study as death or allograft loss – occurred in 24 per cent of young adults within two years following transfer, compared to no death or allograft loss in the transition clinic group during the study period.”

She also points to the cost effectiveness of the clinic. Estimates indicate the average annual per-patient cost for pre-transition clinic patients who lost their allograft and returned to dialysis was $40,000 to $60,000 compared to an average annual per-patient cost of $11,000 to $34,000 for patients provided with transition clinic care.

And those figures only take into account the costs that are easily measured, says Dr. Prestidge. “A young person’s return to dialysis or their untimely death also has major cost implications with regards to lost productivity and contribution to society and family life, and this is certainly not reflected in the dollar figures. This is the first study that compares outcomes in the same centre before and after the institution of transition clinic care, and the only study to evaluate cost implications.”

To build on the positive impact of the transition clinic, Drs. Matsuda-Abedini and Prestidge hope to identify adult nephrologists with an interest in working with adolescents to continue this care model on the adult side of the continuum.

The study, which will be published in a future issue of Pediatric Nephrology, was supported by the BC Provincial Renal Agency, an agency of the Provincial Health Services Authority.

BCPRA plans and coordinates health care services for patients with kidney disease in British Columbia, working cooperatively with a province-wide network of renal care providers. For more information about kidney care services in BC, visit www.bcrenalagency.ca