Understanding the teenage brain, engaging peer support, and integrating social media into patient education are just some of the tips for effective transition of children and young people (CYP) with CKD through to adult renal care.
The advice, published in the Clinical Kidney Journal [link here], come from the evidence and the collective experience of a group of UK and German paediatric and adult neurologists and a former patient.
They said one of the challenges associated with establishing a dedicated transition clinic is the effort and costs in establishing and coordinating a “substantial multidisciplinary team” including paediatricians and adult physicians, paediatric and adult nurses, psychologists or social workers, youth workers, pharmacists and educators.
“Youth workers in particular provide a vital connection between CYP and health care professionals, foster engagement, social prescribing and networking, and employability amongst others,” the paper said.
They also emphasised the importance of understanding the “distinct developmental and separate biopsychosocial needs” of young adults which impact rational decision-making and drive risk-taking behaviours.
“The imbalance between emotion/reward systems and cognitive control networks helps explain why adolescents tend to prefer immediate rewards over delayed gratification, take more risks, and show inconsistent adherence to health recommendations,” it said.
“For example, a teenager may intellectually understand the risks of not taking medication but still prioritise short-term immediate pleasure over long-term health outcomes. A sense of perceived invulnerability can further drive risk-taking behaviours that lead to non-adherence or non-attendance.”
The paper also noted the difference in communication styles required for engaging with CYP – nominally 12-24 years of age – and their families as opposed to adult nephrology patients.
“However, plentiful opportunities also exist: innovative ‘co-created’ clinic approaches and novel educational packages can be created. CYP are often very IT literate which can help with virtual care and telemedicine.”
Their ten top tips are:
- Start the transition process early and aim for continuity of care – allowing time to establish an individual transition plan, educate the patient and their family, gain confidence in self-management, address anxieties and repeatedly review their knowledge and skills.
- Transition is about empowerment – utilise toolkits which open conversations, ensure issues aren’t missed, prompt patient-centred interventions, and provide a framework to guide transition and monitor progress in an objective manner.
- Learn about neurodevelopment and its influence on decision making and risk taking – younger patients may struggle to fully assume responsibility for their own health care given brain maturation into the mid-20s is normal.
- Signpost peer support structures and foster a sense of community – so CYP can share coping strategies and discuss sensitive issues in a confidential environment free of medical judgement and stigma.
- Provide support for medication adherence challenges – practical strategies include simpler dosing regimens, setting reminders or timers on phones, pharmacists to support drug education, peer support, discrete dosette boxes, point of care testing and investigations conducted closer to home.
- Utilise social media for education – recognising that the internet and social media are not just to source information but also to share lived experiences and seek emotional support from peers.
- Focus on mental health and identify resources to provide support – young adults on kidney replacement therapy face higher levels of depression and anxiety, poorer quality of life and worse wellbeing than their healthy peers.
- Develop a multidisciplinary team for a holistic approach – a diversity in skills enables comprehensive, patient-centred care.
- Think of education and employability – as a lack of support in education or work can undermine independence, long-term wellbeing and transition success.
- Identify regional and national sources of support and funding – as local initiatives for transition usually work better when embedded in a framework of national guidance and support.
Australian perspective
Kidney Health Australia (KHA) spokesperson Ms Roxanne Perry told the limbic that transition services were available in all Australian states and were largely in line with the principles in the UK article.
“People understand that just because you turn 18 doesn’t necessarily mean all of a sudden you’re an adult, and that you can deal with all the adult things…especially if they have had a chronic illness their whole life. Some of them have growth issues, and there are lots of complex medical needs… moving from your parents looking after those needs to looking after yourself is a big step for kids to make.”
However, she said the small number of CYP with kidney failure in Australia, the logistics of our geography, and funding challenges, compromised what could reasonably be delivered.
“Our clinics are very good… modelled on some of the things they’ve done overseas in Europe and the US,” she said.
“Most of the major paediatric hospitals now in Australia have a transition service, which is fantastic, and not just for kidney, but for all children with chronic illness. I think they realised there was a gap there – there are 700 of our kids and there are other rare childhood diseases where the kids need to go through the same process of transitioning through a paediatric service into an adult service.”
Ms Perry, Kidney Health Manager at NKA, said their initiatives to further support CYP in the community included the largely educational Kidney Health 4 Youth program, activities such as Kidney Kids Es-Caper events for CYP and their families, peer support via Kidney Youth Champions, and the Kidney Helpline.
She said one of the gaps in care was for young people newly diagnosed with CKD.
“We do find a lot of young adults that get diagnosed with kidney disease and end up on dialysis in their late teens or early 20s – they don’t necessarily get the transition support.”
“We get phone calls from people that say ‘I’m 21 and I’ve just had to start dialysis, and I’m trying to do uni’… so we do link them in with our peer support networks.”
Ten tips for a transition clinic from paediatric to adult nephrologyhttps://t.co/vKoMy6oE0p pic.twitter.com/QmrCDZjCtT
— CKJ (@CKJsocial) November 17, 2025