Abstract: TH-PO535

Clinical Profile and Outcomes of Young Adult Patients with CKD at Philippine General Hospital under the Pediatric to Adult Transition Program Lipat Kalinga

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Author

  • Vieja, Dianne Victoria, UP-Philippine General Hospital, Manila, NCR, Philippines
Background

Advances in the care of patients with CKD resulted in substantial improvement in survival. More patients transfer from pediatric to adult medicine department, instigating the need for proper transition programs- a purposeful, planned movement from child-centered to adult-oriented health services. ISN-PNA in 2011 recommended development of locally appropriate practices for transferring patients. This study describes the transition experience of a pioneer transition program in a low-resources environment.

Methods

A retrospective chart review of 48 transitioned patients from 2011- 2016 was conducted. General data and laboratory parameters before transition and 2 years later were obtained. The no.of hospitalizations, ER consults, OPD followup and the rate of renal function decline after 2 years were also noted.

Results

One hundred thirteen patients were enrolled in the transition program from 2011- 2016. Sixtyfive (58%) patients were not transitioned, 31% were lost to follow-up before transfer. Fortyeight patients completed the transition process,but more than half disengaged from care. Nineteen patients (42%) were actively following up. Mean transition score was 81.18% and it was not associated with the no. of followup, hospital admissions and ER consults. Majority of patients missed their first scheduled adult followup. Mean no. of followup per year was 2 at an average of 1 consult in 6 months. Five patients were admitted post transition with 5 days mean hospital stay. Four patients had ER consults with a mean of 1 ER and 1 hospital admission per year. Fourteen of the patients had a higher BMI 2 years after with mean increase of 1.05 points. There was no significant difference between the baseline and the posttransfer laboratories (electrolytes, albumin, hemoglobin, proteinuria, creatinine and BUN). Mean decline in renal function was 1 ml/min/1.7 per year. There was no significant change in the eGFR of patients before and 2 years after transition.

Conclusion

To improve outcomes of young patients with CKD as they transfer to adult-focused services, transition preparation is critical. In this pioneer group, follow-up rate was only 42%. Obvious difficulties encountered suggest developing more standardized transition methods and strenghtening adult Nephrology participation in the pre-transfer period.