Barday Zibya, Wearne Nicola, Jones Erika S W, McCulloch Mignon, Hoare Jacqueline, Manning Kathryn, Pretorius Suzanne, Davidson Bianca J
Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Nephrology (Carlton). 2025 Sep;30(9):e70110. doi: 10.1111/nep.70110.
Adolescents and young adults (AYAs) are increasingly utilising kidney health care services. However, there is no data on the impact of kidney transition clinics, as well as the AYA spectrum of kidney diseases, in South Africa (SA). This study evaluates kidney outcomes and patient survival amongst AYA patients attending a dedicated kidney AYA clinic (KAYAC).
This 5-year retrospective study included AYA (aged 13-25) with kidney disease, attending a tertiary nephrology service. A comparative analysis of outcomes between patients who attended the KAYAC and those attending the standard-of-care adult kidney clinics was performed. The primary composite outcome assessed included doubling of creatinine, reduction in eGFR > 40%, kidney failure, requirement for kidney replacement therapy, or death. Logistic regression evaluated the associations between relevant variables, death, and loss to follow-up (LTFU).
The AYA cohort consisted of 292 patients: 111 (38.0%) attended KAYAC and 181 (62.0%) attended adult clinics. Glomerular diseases (72.6%), congenital urinary tract anomalies (10.6%) and hereditary conditions (8.2%) were the most common causes of kidney disease. The KAYAC group had delayed progression to kidney failure with an improved composite outcome (p = 0.018), lower mortality (p = 0.046) and less LTFU (p = 0.001). Both groups demonstrated high rates of non-adherence, with a prevalence of 33.9% in the total cohort.
AYA are a unique population who could benefit from KAYAC transition clinics. A dedicated KAYAC has been found to be associated with better kidney outcomes, lower mortality and less LTFU, underscoring its critical role in resource-limited settings.
青少年和青年（AYA）对肾脏保健服务的利用越来越多。然而，在南非（SA），尚无关于肾脏过渡诊所的影响以及AYA肾脏疾病谱的数据。本研究评估了在专门的AYA肾脏诊所（KAYAC）就诊的AYA患者的肾脏结局和患者生存率。
这项为期5年的回顾性研究纳入了患有肾脏疾病、在三级肾脏病服务机构就诊的AYA（年龄13 - 25岁）。对在KAYAC就诊的患者和在成人标准肾脏诊所就诊的患者的结局进行了比较分析。评估的主要复合结局包括肌酐翻倍、估算肾小球滤过率（eGFR）降低>40%、肾衰竭、肾脏替代治疗需求或死亡。逻辑回归评估了相关变量、死亡和失访（LTFU）之间的关联。
AYA队列由292名患者组成：111名（38.0%）在KAYAC就诊，181名（62.0%）在成人诊所就诊。肾小球疾病（72.6%）、先天性尿路异常（10.6%）和遗传性疾病（8.2%）是肾脏疾病最常见的病因。KAYAC组进展至肾衰竭的时间延迟，复合结局改善（p = 0.018），死亡率较低（p = 0.046），LTFU较少（p = 0.001）。两组的不依从率都很高，在整个队列中的患病率为33.9%。
AYA是一个独特的人群，可从KAYAC过渡诊所中受益。已发现专门的KAYAC与更好的肾脏结局、更低的死亡率和更少的LTFU相关，突显了其在资源有限环境中的关键作用。
