Association of depression and anxiety with reduced quality of life in patients with predialysis chronic kidney disease

AIM

Although depression and anxiety are the most common psychological problems among dialysis patients, little is known about the association between depression, anxiety and quality of life (QOL) in patients with predialysis chronic kidney disease (CKD). Therefore, we assessed the prevalence of depression and anxiety, and their association with QOL in patients with predialysis CKD.

METHODS

Two hundred and eight predialysis patients (male 61.1%) with a mean age of 55.7 ± 13.7 years and an estimated glomerular filtration rate < 60 ml/min/1.73 m(2) were enrolled. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. Patients with anxiety and depression scores ≥ 8 were diagnosed with anxiety and depression disorders respectively. The WHOQOL-BREF questionnaire was used to assess patient QOL.

RESULTS

The prevalence of depression (47.1%) and anxiety (27.6%) did not differ across CKD stages. Depression correlated positively with age, employment, income, education, comorbidity index, haemoglobin level, albumin concentration and anxiety score, and negatively with all WHOQOL-BREF domain scores. Anxiety correlated significantly with QOL, but not with socioeconomic factors. In a multiple regression analysis, haemoglobin level, anxiety and QOL were independent factors associated with depression. In a linear regression analysis, depression and anxiety independently correlated with QOL after we adjusted for age, alcohol use, employment, income, education, haemoglobin level and albumin concentration.

CONCLUSIONS

Patients with predialysis CKD have a high prevalence of depression and anxiety, which are associated with reduced QOL. Early detection of depression and anxiety and active interventions should be considered to improve the QOL of these patients.

The relationship between spirituality, psychosocial adjustment to illness, and health-related quality of life in patients with advanced chronic kidney disease

CONTEXT

Spirituality may promote psychosocial adjustment to illness, and this may be a mechanism by which patients with greater existential well-being (EWB) experience better health-related quality of life (HRQL) in the context of life-limiting illness.

OBJECTIVES

This study explored the relationship between psychosocial adjustment to illness, EWB, and HRQL in patients with advanced chronic kidney disease and sought to determine whether adjustment to illness mediates the relationship between EWB and HRQL.

METHODS

This was a cohort study of 253 prevalent Stage 4 or 5 chronic kidney disease and dialysis patients. Participants completed the Spiritual Well-Being Scale, the Psychological Adjustment to Illness Scale (PAIS)-Self-Report, and the Kidney Dialysis Quality of Life Short Form.

RESULTS

Psychosocial adjustment to illness was highly correlated with HRQL, accounting for 29% and 27% of the variance in physical and mental HRQL scores, respectively. Although PAIS domains were associated with EWB, EWB remained a significant predictor of HRQL after all PAIS domains were considered. Adjustment in the domains of psychological distress and extended family relationships did appear to mediate some of the relationship between EWB and HRQL.

CONCLUSION

Adjustment in the domains of psychological distress and extended family relationships appears to mediate some of the beneficial effect of EWB on HRQL. Spirituality, however, provides unique variance in patients' HRQL, independent of their psychosocial adjustment. This study testifies to the importance of targeting both psychosocial adjustment to illness and spirituality as ways to preserve or enhance HRQL of predialysis and dialysis patients.

Healthy behaviors, risk factor control and awareness of chronic kidney disease

BACKGROUND/AIMS

The association between chronic kidney disease (CKD) awareness and healthy behaviors is unknown. We examined whether CKD self-recognition is associated with healthy behaviors and achieving risk-reduction targets known to decrease risk of cardiovascular morbidity and CKD progression.

METHODS

CKD awareness, defined as a 'yes' response to 'Has a doctor or other health professional ever told you that you had kidney disease?', was examined among adults with CKD (eGFR <60 ml/min/1.73 m(2)) who participated in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Odds of participation in healthy behaviors (tobacco avoidance, avoidance of regular nonsteroidal anti-inflammatory drug use, and physical activity) and achievement of risk-reduction targets (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, systolic blood pressure control and glycemic control among those with diabetes) among those aware versus unaware of their CKD were determined by logistic regression, controlling for sociodemographics, access to care and comorbid conditions. Systolic blood pressure control was defined as <130 mm Hg (primary definition) or <140 mm Hg (secondary definition).

RESULTS

Of 2,615 participants, only 6% (n = 166) were aware of having CKD. Those who were aware had 82% higher odds of tobacco avoidance compared to those unaware (adjusted OR = 1.82, 95% CI 1.02-3.24). CKD awareness was not associated with other healthy behaviors or achievement of risk-reduction targets.

CONCLUSIONS

Awareness of CKD was only associated with participation in one healthy behavior and was not associated with achievement of risk-reduction targets. To encourage adoption of healthy behaviors, a better understanding of barriers to participation in CKD-healthy behaviors is needed.

[Specific features of cognitive impairments in patients with predialysis chronic kidney disease]

AIM

To study the specific features of cognitive impairments (CI) in patients with predialysis chronic kidney disease (CKD).

SUBJECTS AND METHODS

Examinations were made in 51 patients aged 52 +/- 10 years with CKD, including 20 patients with Stages I-II CKD (glomerular filtration rate (GFR) > or = 60 ml/min/1.73 m2; signs of kidney lesion), 20 with Stage III (GFR 60-30 ml/min/1.73 m2), and 11 with Stage IV (GFR 30-15 ml/min/1.73 m2). GFR was estimated using the Modification of Diet in Renal Disease (DMRD) formula. The authors made a questionnaire survey to identify day-to-day activity limitations and depressions and performed neuropsychological tests using the mini-mental state examination (MMSE), a frontal assessment battery (FAB) for frontal lobe dysfunction, a short-term and delayed memory test (Luria's 10 words test), and a regulatory function assessment test (RFAT). Magnetic resonance imaging (MRI) was carried out to clarify the etiology of CI.

RESULTS

CI was detected more frequently in the patients with chronic renal failure (CRF) (Stages III-IV CKD) than in those without CRF (Stages I-II CKD) (in 90.3 and 35%, respectively (p < 0.001)). CI was statistically significantly more frequently found using MMSE (p < 0.001), FAB (p = 0.001), and RFAT (p < 0.001). There was a statistically significant rise in the magnitude of CI with the higher stage of CKD, as shown by MMSE, FAB, and RFAT, other than the short-term and delayed memory test. Brain MRI in the patients with CI revealed focal changes in 9 (30%) patients, leukoaraiosis in 7 (23.3%), lateral cerebral ventricular dilatation in 15 (50%), and markedly dilated hemispheric sulci in 3 (10%).

CONCLUSION

The higher stage of CKD is associated with the increased incidence and magnitude of CI, as evidenced by MMSE, and with those of anterior brain dysfunctions. The comparisons of clinical and MRI findings suggest that cerebrovascular disorders underlie CI in CKD.

Empowerment intervention in outpatient care of persons with chronic kidney disease pre-dialysis

Empowering interventions can improve person-centered care. A pre- and post-evaluation using interactive research involving two years of empowering interventions was designed to improve quality of care in outpatients with chronic kidney disease who were pre-dialysis. The results showed significantly increased empowerment in the intervention group. Interactive research facilitated the implementation of the empowerment intervention, which may increase sustainability over time.

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study

BACKGROUND

Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management.

AIM

To explore processes underpinning the implementation of CKD management in primary care.

DESIGN AND SETTING

Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester.

METHOD

Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data.

RESULTS

A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions.

CONCLUSION

Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity.

Is awareness of chronic kidney disease associated with evidence-based guideline-concordant outcomes?

BACKGROUND

Awareness of chronic kidney disease (CKD) is low. Efforts are underway to increase recognition of CKD among patients, assuming that such an increase will lead to better outcomes through greater adherence to proven therapies. Few studies have tested this assumption.

METHODS

CKD awareness, defined by a 'yes' answer to 'Have you ever been told by a healthcare provider you have weak or failing kidneys?', was assessed among 2,404 adults with CKD stages 1-4, who participated in the 2003-2008 National Health and Nutrition Examination Surveys. Odds of blood pressure (BP) control, self-reported use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), and glycemic control, were determined among those aware vs. unaware of their CKD.

RESULTS

Optimal BP control, ACEI/ARB use and glycemic control were low in the US adult population with CKD, although there was a recent increase in attainment of guideline-concordant BP control. Odds of BP control and ACEI/ARB use were not different among individuals aware of their CKD compared to those unaware (adjusted odds ratio (AOR) 0.91; 95% CI 0.52-1.58 and AOR 0.75; 0.44-1.30, respectively). CKD awareness among diabetic participants was not associated with glycemic control (AOR 0.41; 95% CI 0.14-1.18).

CONCLUSION

Awareness of CKD is not associated with more optimal BP control, ACEI/ARB use or glycemic control. Future efforts in this area should further explore the measurement of CKD awareness and behaviors associated with CKD awareness.

Progression of cognitive dysfunction in elderly chronic kidney disease patients in a veteran's institution in central Taiwan: a 3-year longitudinal study

OBJECTIVE

A strong positive correlation between estimated glomerular filtration rate (eGFR) multiplied by follow-up time and memory function has been demonstrated previously. The purpose of this study was to investigate the factors affecting progression of cognitive dysfunction in the elderly with different levels of kidney function.

METHODS

In April 2002, a prospective study on progression of cognitive function was conducted on 356 elderly people. All participants received a comprehensive geriatric assessment, serum biochemical test, homeostasis model assessment (HOMA), and a genetic polymorphism study, including polymorphism of apolipoprotein E (APOE), Cystatin, C-reactive protein (CRP) and tumor necrosis factor (TNF). Lean body mass-adjusted eGFR was used to evaluate severity of chronic kidney disease (CKD), and a clinical dementia rating scale was used to assess cognitive dysfunction. Patients were stratified according to eGFR (≥49 mL/min and <49 mL/min).

RESULTS

Using multivariate logistic regression models, older age (OR=1.27, 95% CI=1.00-1.61) was associated with a high risk for progression of cognitive function in patients with a relatively low eGFR. In patients with lower eGFR, higher mini-mental state examination (MMSE) scores (OR=0.23, 95% CI=0.10-0.54) were correlated with a low risk for progression of cognition, while in patients with higher eGFR, higher MMSE scores (OR=0.39, 95% CI=0.23-0.65) were less correlated with cognitive dysfunction. However, elevated serum plasminogen activator inhibitor-1 (PA1-1) was associated with a high risk for cognitive dysfunction (OR=1.06, 95% CI=1.01-1.11) in patients with a better eGFR.

CONCLUSION

Age, MMSE score and serum PAI-1 were found to be factors that predicted cognitive dysfunction at different functional levels of CKD.

Elevated depressive affect is associated with adverse cardiovascular outcomes among African Americans with chronic kidney disease

This study was designed to examine the impact of elevated depressive affect on health outcomes among participants with hypertensive chronic kidney disease in the African-American Study of Kidney Disease and Hypertension (AASK) Cohort Study. Elevated depressive affect was defined by Beck Depression Inventory II (BDI-II) thresholds of 11 or more, above 14, and by 5-Unit increments in the score. Cox regression analyses were used to relate cardiovascular death/hospitalization, doubling of serum creatinine/end-stage renal disease, overall hospitalization, and all-cause death to depressive affect evaluated at baseline, the most recent annual visit (time-varying), or average from baseline to the most recent visit (cumulative). Among 628 participants at baseline, 42% had BDI-II scores of 11 or more and 26% had a score above 14. During a 5-year follow-up, the cumulative incidence of cardiovascular death/hospitalization was significantly greater for participants with baseline BDI-II scores of 11 or more compared with those with scores <11. The baseline, time-varying, and cumulative elevated depressive affect were each associated with a significant higher risk of cardiovascular death/hospitalization, especially with a time-varying BDI-II score over 14 (adjusted HR 1.63) but not with the other outcomes. Thus, elevated depressive affect is associated with unfavorable cardiovascular outcomes in African Americans with hypertensive chronic kidney disease.

Anemia normalization in patients with type 2 diabetes and chronic kidney disease: results of the NEPHRODIAB2 randomized trial

STATEMENTS OF THE PROBLEM

Correction of anemia in type 2 diabetes (T2DM) patients with chronic kidney disease stages 3-4 may slow the decline of kidney function but may increase cardiovascular risk through higher hematocrit. The NEPHRODIAB2 study was designed to assess efficacy and safety of complete hemoglobin (Hb) normalization in these patients.

METHODS

We randomly assigned 89 T2DM patients with an estimated glomerular filtration rate (eGFR; abbreviated 175 Modification of Diet in Renal Disease formula) of 25 to 60 ml/min per 1.73 m(2) and moderate anemia (Hb, 100-129 g/l) to a target Hb value in subnormal range (110-129g/l, group 1, n=43) or normal range (130-149 g/l, group 2, n=46). The primary end point was eGFR decline after 2 years of follow-up. Secondary end points included iron and erythropoietin dosage, quality of life (Medical Outcomes Study 36-item Short-Form Health Survey scores) and adverse events.

RESULTS

Six months after randomization, the mean Hb levels were <120 g/l in group 1 and >130 g/l in group 2 (P<.05 at 6, 12, 18 and 24 months). Blood pressure, 24-h proteinuria and HbA1c did not differ during follow-up (P>.05). Two-year declines in eGFR were -8.7±12.2 in group 1 and -5.1±7.8 ml/min per 1.73 m(2) in group 2 (P=.29). Mean weekly use of erythropoietin was 7.8±11.6 μg in group 1 and 30.1±33.6 μg in group 2 (P<.0001). There was no significant difference regarding Medical Outcomes Study 36-item Short-Form Health Survey score change or adverse event occurrence.

CONCLUSIONS

In this trial, normalization of Hb level in T2DM patients with chronic kidney disease was safe but did not significantly slow renal function decline and increased treatment cost due to erythropoietin use.

Relationship between uric acid and subtle cognitive dysfunction in chronic kidney disease

BACKGROUND

Elevated serum uric acid has been associated with cognitive dysfunction and vascular cognitive impairment in the elderly. Serum uric acid is also commonly elevated in chronic kidney disease (CKD), but its relationship with cognitive function in these patients has not been addressed.

METHODS

Subjects with CKD (defined as eGFR <60/ml/min/1.73 m(2)) were evaluated for cognitive dysfunction using the validated Standardized Mini-Mental State Examination (SMMSE). Individuals with dementia, depression or other psychiatric disorders were excluded, as were subjects on uric acid-lowering therapy or with serious illnesses such as severe anemia or active or ongoing cardiovascular or cerebrovascular disease.

RESULTS

247 subjects were enrolled. SMMSE scores showed stepwise deterioration with increasing quartile of serum uric acid (26.4; 26.1; 25.5; 25.3, score range 20-30, p = 0.019). Post-hoc analysis demonstrated that there was no linear trend and only groups 1 and 4 were different with respect to SMMSE scores (p = 0.025). Stepwise multivariate linear regression revealed that age, educational status, presence of cerebrovascular disease, and serum uric acid were independently related to SMMSE scores.

CONCLUSION

Serum uric acid levels are independently and inversely associated with mild cognitive dysfunction in subjects with CKD.

Patient perception of risk factors associated with chronic kidney disease morbidity and mortality

BACKGROUND

Educational interventions aimed at empowering patients are successful in chronic disease management. The purpose of this study was to assess patient knowledge of risk factors and complications associated with chronic kidney disease (CKD).

METHODS

We determined the perception of risk factors for CKD and its complications in 229 participants with a diagnosis of CKD stage 3 and 4 who completed an anonymous questionnaire. We evaluated predictors of better knowledge as measured by total correct responses using linear regression.

RESULTS

The majority (89.1%) but not all of participants were aware of their diagnosis of CKD. Almost a third (31.5%) of patients that were aware of a diagnosis of CKD did not know their serum creatinine level compared to only 15.4% of participants with diabetes who did not know their last serum glucose level. Most participants identified hypertension (92.1%) and diabetes (86%) as risk factors for CKD, but male sex (59%) and African American race (71.6%) were selected less frequently. While glucose, proteinuria and blood pressure control were commonly associated by participants as known methods to slow progression of CKD, smoking control (79.5%) and use of renin-angiotensin system inhibitors (63.8%) were less known. After adjustment for sociodemographic factors, younger age and presence of a college degree were the only independent predictors of knowledge of CKD risk factors.

CONCLUSIONS

Access to CKD education needs to be tailored to the health literacy status of each patient. Educational interventional research studies are needed in early-stage CKD to determine impact on clinical outcomes.

Prevalence and awareness of CKD among African Americans: the Jackson Heart Study

BACKGROUND

Chronic kidney disease (CKD) leads to end-stage renal disease and is a growing epidemic throughout the world. In the United States, African Americans have an incidence of end-stage renal disease 4 times that of whites.

STUDY DESIGN

Cross-sectional to examine the prevalence and awareness of CKD in African Americans.

SETTING & PARTICIPANTS

Observational cohort in the Jackson Heart Study (JHS).

PREDICTOR

CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2), the presence of albuminuria, or dialysis therapy.

OUTCOMES & MEASUREMENTS

Data from the JHS were analyzed. Medical history, including disease awareness and drug therapy, anthropometric measurements, and serum and urine samples, were obtained from JHS participants at the baseline visit. Associations between CKD prevalence and awareness and selected demographic, socioeconomic, health care access, and disease status parameters were assessed by using logistic regression models.

RESULTS

The prevalence of CKD in the JHS was 20%; CKD awareness was only 15.8%. Older participants had a greater prevalence, but also were more aware of CKD. Hypertension, diabetes, cardiovascular disease, hypercholesterolemia, hypertriglyceridemia, increasing age and waist circumference, and being single or less physically active were associated with CKD. Only advancing CKD stage was associated with awareness.

LIMITATIONS

Cross-sectional assessment, single urine measurement.

CONCLUSIONS

The JHS has a high prevalence and low awareness of CKD, especially in those with less severe disease status. This emphasizes the need for earlier diagnosis and increased education of health care providers and the general population.

Brief report: intellectual and academic functioning in pediatric chronic kidney disease

OBJECTIVE

Examine the intellectual and academic functioning in children with chronic kidney disease (CKD).

METHODS

Using a cross-sectional design, children with CKD (n = 30) were compared to matched controls (n = 41) on measures of intelligence, achievement, and rates of learning disabilities (LD) variously defined.

RESULTS

Children with CKD were at higher risk for grade retention (p < .001) and absenteeism (p < .01), and evidenced mild impairments on measures of intelligence (p < .001), math (p < .01), reading (p < .05), and satisfied criteria for a low achievement definition of LD (p < .01) more frequently than control group participants. Renal function was a significant predictor (p < .02) of intellectual and academic scores in the CKD group.

CONCLUSIONS

Educational and psychosocial supports are critical for children with CKD, and it may be important to monitor their cognitive functioning and academic progress over time.

[The level of approval in selected chronic diseases]

Every somatic disease causes difficulties and negative emotions. It makes people limit or change their social roles. Approval of the disease is a significant factor in the process of adaptation to it. Approving the disease significantly influences the reduction of negative emotional reactions it causes. The paper attempts to define the degree of disease approval among the patients with the following illnesses: diabetes, bronchial asthma, cardiac ischaemia, chronic renal insufficiency.

MATERIAL AND METHODS

The study was carried out on 121 subjects, the patients of the district hospital in the Lublin Region. The study applied Approval Illness Scale (AIS)--B.J. Felton, T.A. Revenson, C.A. Hinrichsen, adapted in Poland by Z. Juczyński. It consists of 8 statements describing consequences of bad health condition.

RESULTS

The analysis of the obtained results confirmed a similar approval level in comparable illnesses. However a correlation was confirmed between the level of illness approval and the sex, age and place of living.

Health-related quality of life and estimates of utility in chronic kidney disease

BACKGROUND

Health-related quality of life and estimates of utility have been carefully evaluated in persons with end-stage renal disease. Fewer studies have examined these parameters in persons with chronic kidney disease (CKD).

METHODS

To determine the relations among kidney function, health-related quality of life, and estimates of utility, we administered the Kidney Disease Quality of Life Short Form 36 (KDQOL-36), Health Utilities Index (HUI)-3, and Time Trade-off (TTO) questionnaires to 205 persons with CKD. Persons with CKD stages 4 and 5 (estimated GFR <30 mL/min/1.73 m2, N= 115) were tested two to eight times over the subsequent two years. The relations among estimated glomerular filtration rate (eGFR), and changes in health-related quality of life and utility over time were estimated using mixed effect regression models. Models were adjusted for age, sex, race, and diabetes.

RESULTS

Mean scores on the KDQOL-36 generic components, HUI-3, and TTO suggested considerable loss of function and well-being in CKD relative to population norms. On cross-sectional analysis, lower levels of kidney function were associated with significantly lower scores on the SF-12 Physical Health Composite (P= 0.002), the Burden of Kidney Disease subscale (P < 0.0001), and the Effects of Kidney Disease subscale (P < 0.0001) of the KDQOL-36trade mark. Kidney function was significantly associated with the TTO (P= 0.008) and global HUI-3 utility (P= 0.016) although these associations were attenuated after adjustment for diabetes. A decline in eGFR was associated with a significant increase in the reported Burden of Kidney Disease (5.0 point change per year per mL/min/1.73 m2 decline in eGFR) and with marginally significant changes in the Dexterity and Pain attributes of the HUI-3. Mean HUI-3 scores for persons with CKD stages 4 and 5, absent dialysis, were in the range previously reported for persons with stroke and severe peripheral vascular disease.

CONCLUSION

Health-related quality of life and estimates of utility are distressingly low in persons with CKD. Self-reported outcomes should be considered when evaluating health policy decisions that affect this population.

The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: A randomized trial

BACKGROUND

Compared with in-center hemodialysis, self-care dialysis (including home and self-care hemodialysis and peritoneal dialysis) is less resource intensive and associated with similar clinical outcomes. However, utilization of self-care dialysis has been very low. We performed a randomized controlled trial in predialysis patients with chronic kidney disease (CKD) (GFR <30 mL/min) to determine the impact of a patient-centered educational intervention on patients' intention to initiate dialysis with self-care dialysis.

METHODS

Seventy patients with CKD who were receiving care in a multidisciplinary predialysis clinic were randomized to receive either (1) a two-phase patient-centered educational intervention (phase 1 included educational booklets and a 15-minute video on self-care dialysis; phase 2 included a 90-minute small group interactive educational session on self-care dialysis) in addition to their regular multidisciplinary care, or (2) ongoing standard care and education in the multidisciplinary predialysis clinic. The primary outcome was patients' intention to initiate dialysis with self-care dialysis, assessed by questionnaire.

RESULTS

Thirty-five patients were randomized to standard care; 34 completed the study. Thirty-five patients were randomized to the educational intervention; 30 completed phase 1 and 28 completed phase 2. By study end, significantly more patients in the intervention group (82.1%) intended to start dialysis with self-care dialysis compared with the standard care group (50%, P= 0.015). This difference persisted after controlling for the small baseline differences among patients in the two study groups (P= 0.004).

CONCLUSION

A two-phase educational intervention can increase the proportion of patients who intend to initiate dialysis with self-care dialysis.

Transition from pediatric to adult medical care

Because of recent medical advances, the number of children with chronic medical conditions who survive into adulthood has increased. The transition of care from pediatric to adult specialists and subspecialists has been rarely studied, yet it is an important aspect of care. To define issues in the pediatric patients at the University of Virginia, survey data was collected from adult nephrologists in the state. A total of 105 surveys were mailed to adult providers in Virginia. From 62 responses, 60% of adult providers did not feel completely comfortable caring for a patient with a pediatric-specific diagnosis. To efficiently receive information on new patients, adult providers preferred an abbreviated medical summary or phone call from pediatric providers. Additionally, interviews were conducted with 6 pediatric patients and their families. Patients reported a good grasp of their diagnosis and treatment, expressed an interest in learning chronic-illness coping strategies, and expressed interest in obtaining community-resource information. This study reiterated the need for additional insurance options for this at-risk population. Development of individualized transition plans and transition services are recommended to support young adult patients with chronic medical conditions as they transition into adulthood.