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Chronische Nierenerkrankung und Transition

Übergang von Adoleszenten von der pädiatrischen in die internistische Betreuung
  • J. Prüfe
  • L. Pape
  • M. KreuzerEmail author
Leitthema
  • 17 Downloads

Zusammenfassung

Internistische Nephrologen sind mit einer wachsenden Zahl von Patienten konfrontiert, die im Kindes- und Jugendalter eine chronische Nierenerkrankung entwickelt haben und aus der pädiatrischen in ihre Betreuung wechseln. Findet dieser Wechsel nach einer geplanten Vorbereitung der Patienten statt, spricht man von Transition. Davon abzugrenzen ist der Transfer, der nur die kurze Zeit des Wechsels bezeichnet. Transition ist dann erfolgreich, wenn sie den Patienten einen Übergang von einer passiven Rolle in der Kinderheilkunde zu erfolgreichem Selbstmanagement in der Erwachsenenmedizin ermöglicht. Hirnorganische und psychosoziale Veränderungen zwischen dem 11. und 26. Lebensjahr führen zu besonderem Risikoverhalten und dem Drang, Neues auszuprobieren. Dies geht mit einem erhöhten Risiko in der Zeit des Wechsels einher und kann zur Progression von Krankheit und/oder Niereninsuffizienz und zu Transplantatabstoßungen und -verlusten führen. In den 4 Ebenen Patient, Umfeld, Gesundheitssystem und Arzt lassen sich Transitionsbarrieren finden, die ggf. überwunden werden müssen. Die Krankheitsbilder dieser Patientengruppe sind oft angeboren, selten, und diese Patienten benötigen auch als Erwachsene einen multidisziplinären Therapieansatz. Viele retrospektive Studien haben einen Vorteil für den Einsatz von Transitionsprogrammen gezeigt. Als wesentliches Merkmal wird die Adhärenz verbessert. Richtlinien zur Transition wurden von den Fachgesellschaften auf dem Boden von Expertenmeinungen und von retrospektiven Studien veröffentlich. Veröffentlichte prospektive Studien sind noch selten, neue randomisierte Studien laufen aktuell noch. Finanzielle und personelle Ressourcen für die Transitionsmedizin sind in Deutschland knapp, was eine Implementation der Guidelines in die klinische Praxis erschwert. Die Finanzierung von Transitionsprogrammen in der Regelversorgung zu implementieren ist ein wichtiges Ziel für die Zukunft.

Schlüsselwörter

Patiententransfer Chronische Nierenerkrankung Pädiatrische Nephrologie Adoleszenz Nonadhärenz 

Abkürzungen

IPNA

International Pediatric Nephrology Association

ISN

International Society of Nephrology

Chronic kidney disease and transition

Transfer of adolescents from pediatric to adult internistic medical care

Abstract

Internistic nephrologists are facing an increasing number of patients with chronic kidney disease since childhood and/or adolescence. As adults these patients have to transfer from pediatric to adult medical care. While transfer refers to the mere change of medical caregivers, transition describes a structured period of preparing the patient to facilitate transfer. Transition is deemed successful if the patient matures from a dependent child into an independent adult who, with the help of physicians, is capable of self-management. Between 11 and 26 years old neurological as well as psychosocial changes can cause a gap between knowing what to do and doing what is known. This leads to a disposition for risk-taking behavior in general and non-adherence in particular with a higher incidence of disease progression, transplant rejection and transplant loss in these years. Barriers to successful transition can be found on four levels: (1) the patient, (2) the social environment, (3) the health system and (4) the physician, which if necessary, must all be overcome. Primary renal diseases in this particular group of patients are frequently congenital, predominantly rare and often require a multidisciplinary approach to treatment even during adulthood. Many retrospective studies have shown a benefit of transition programs, which help to improve patient adherence. Guidelines for transition have been designed by the professional bodies based on these retrospective studies and expert opinions. Prospective studies, however, are scarce and a few randomized studies are still running but the results are as yet unpublished. In Germany, financial and staff resources are limited with respect to transition medicine, which hampers the clinical implementation of study findings and recommendations. To cover financing of these programs by national health insurances is an important goal for the near future.

Keywords

Patient transfer Chronic kidney disease Pediatric nephrology Adolescence Nonadherence 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Prüfe, L. Pape und M. Kreuzer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Pädiatrische Nieren‑, Leber- & StoffwechselerkrankungenMedizinische Hochschule Hannover (MHH)HannoverDeutschland

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