Pediatric to adult transition in chronic kidney disease: a scoping review.

Abstract

Introduction: Chronic kidney disease (CKD) presents unique medical and psychosocial challenges in children and adolescents that differ from adult patients with CKD. Transitioning from pediatric to adult care is a critical period. Insufficient planning and inadequate preparation increase the risk of medication nonadherence, loss to follow-up, graft failure in transplant patients, and increased morbidity. Transition models address barriers to successful transition, yet vary in their approach.

Methods: We conducted a scoping review of the transition of care in pediatric CKD in accordance with PRISMA-ScR guidelines. We included PubMed/MEDLINE full-text articles, KDIGO guidelines, and grey literature on transition models between 1st January 2000 and 31st August 2025. Eligible studies included original research articles in English, human clinical trials, and guidelines specifically addressing pediatric-to-adult CKD transition of care.

Results: We identified barriers to effective transition at the patient, provider, and system levels. Patients often lacked health literacy, emotional readiness, or independence. Providers faced challenges with communication across pediatric and adult care teams. System-level obstacles included gaps in insurance coverage and limited resources. To assess readiness, models such as ON TRAC, TRAQ, RTQ, and the UNC TRxANSITION offer valuable questionnaires. Early preparation between the ages of 11-14, a gradual increase in patient autonomy, multidisciplinary teams' involvement, and structured transfer clinics are recommended for proper CKD transition.

Discussion: An effective transition is vital for improving both pediatric and adult health outcomes. Future research should focus on standardized protocols such as the Six Core Elements of Health Care Transition and the integration of technology-based tools to better engage adolescent patients. Structured and evidence-based transition models supported by healthcare systems can improve transition.