Problems and pitfalls of transition from paediatric to adult renal care.

Transition is a generic issue for subspecialties dealing with chronic illness and has received little attention to date. Transfer to adult care occurs at the end of a transition process that must be individualised for each patient and takes into account all aspects of growth and development, which may be variably impaired. Good communication with the young person, family and adult nephrologist is essential so that the anxieties of all are properly addressed. Non-compliance with treatment, particularly prevalent in adolescents, requires attention to psychological and social issues as well as medical factors. The young person must have sufficient self-management skills (which should be assessed) and there should be plans for long-term social support before transfer. Transition should be a positive process and models need to be evaluated.