BRIDGING THE GAP: DEMOGRAPHIC AND CLINICAL INSIGHTS FROM SRI LANKA'S FIRST PAEDIATRIC TO ADULT NEPHROLOGY TRANSITION SERVICE

Introduction:

Transitioning from paediatric to adult nephrology care is a critical phase for patients diagnosed with long-lasting kidney disease during childhood. Transition services play a crucial role in managing the transfer of care for these patients. Despite its importance, the transition process is often overlooked in Sri Lanka due to lack of expertise, manpower and infrastructure. This is the first description of a nephrology transition care service established at the Teaching Hospital Peradeniya, Sri Lanka.

Methods:

We conducted a retrospective analysis of patients who attended the transition clinic over four months in 2024. Data on patient demographics, clinical characteristics, and geographic distribution were analyzed.

Results:

The nephrology transition clinic is established within the same premises at the same time as the paediatric nephrology clinic for the young patients and their parents to feel comfortable and safe. A formal referral is made by the paediatric nephrology team and the patient is reviewed for the first time by the adult nephrology team on their original clinic date and time. 

A total of 78 patients were included in the analysis. 55.1% (n=43) of the patients were referred to the transition services after 18 years of age (median 19, IQR – 13-31). The patient population was predominantly male (56.4%, n=44) and of Sinhalese ethnicity (79.5%, n=62). Patients were travelling from various parts of the country with the majority residing within 10 km of the hospital (56.4%, n=44), while 11.5% (n=9) lived 20-40 km from the hospital, 10.3% (n=8) lived 40-60 km from the hospital, 15.4% (n=12) lived 60-80 km from the hospital, and 6.4% (n=5) lived >100 km from the hospital. All patients were accompanied by their parents or guardians. The most common aetiology was glomerulonephritis (GN) (91%, n=71) followed by congenital anomalies of the kidneys and urinary tract (CAKUT) (3.8%, n=3), genetic renal disease (GRD) (2.6%, n=2), and other (2.6%, n=2). Out of the patients with GN, 55.1% (n=43) had steroid-dependent nephrotic syndrome (SDNS), 16.7% (n=13) had steroid-sensitive nephrotic syndrome (SSNS), 14.1% (n=11) had systemic lupus erythematosus (SLE) nephritis, and 3.8% (n=3) had steroid-resistant nephrotic syndrome (SRNS). Among the patients with GN, only 30% (n=21) had undergone a renal biopsy. The mean estimated glomerular filtration rate (eGFR) at presentation was 129 mL/min/1.73m2 (SD±29.5).  Body mass index (BMI) measures demonstrated that 73% (n=57) have a normal BMI,  15.4% (n=12) are obese and 11.53% (n=9) are underweight.

The following table summarizes the demographic and clinical characteristics of the paediatric-to-adult nephrology transition service.

Conclusions:

This study provides the first description of a patient population attending a nephrology transition clinic in Sri Lanka. The age of referral for transition care varied markedly from 13 – 31 years with the predominant disease entity being glomerulonephritis. 15.4% (n=12) were obese indicating side effects of long-term steroid therapy. Understanding these characteristics is crucial to ensure a smooth and effective transition for young patients in the country.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.