Table 6. Integration of evidence across the streams [18].

Stream 1: The specific transition needs and problems experienced by young people with CKD	Stream 2: Effectiveness and wider impacts of interventions to support transition for young people with CKD	Stream 3. The views and experiences of young people with CKD and their parents/families and professionals of transition generally, and interventions to support transition specifically	Gaps
Psychological, developmental, health-related, institutional, socioecological, and vocational issues.	Absence of evidence of the effectiveness or ‘added value’ of integrated health and social care renal teams.	Young people want holistic transition support over a longer period of time.	There is an absence of evidence on the role and impact of integrated health and social care renal teams. The evidence is medically lead and interpreted through a medical lens. There are virtually no studies published from the perspective of renal social work and social care.
Information, explanation, and education regarding the treatment and the importance of adherence.	Very limited evaluation of interventions and no evidenced consensus regarding timings.	Depending on their individual characteristics and comorbidities, young people with CKD may be less capable of fitting with societal norms around taking responsibility for themselves.	Transition is not consistently conceptualised across disciplines. There is an absence of evidence that starting transition early improves outcomes
Importance of social factors during transition.	Pathway interventions evaluated have been process-driven with few non-clinical or long-term evaluations.	Transition should be individualised. Some feel powerless about being told when they can manage their condition, while others worry about taking responsibility for their conditions with life-threatening consequences.	Key conflict / resolution area with little evidence that existing interventions are meeting the personalised clinical and social-care needs of young people, and long-term outcomes remain unknown.
Attachment of young people to children’s units.	Found to have short-term outcomes in terms of adherence and renal function but no measures of non-clinical outcomes for young people.	Children’s services rely on parents and do not always equip young people with the knowledge and skills required to negotiate health systems. Adult clinics viewed very negatively. Families excluded.	Some evidence of positive outcomes but further long-term evaluations of different interventions needed to develop good practice.
Risk of disengagement, isolation, and subsequently poor health, social, educational and vocational outcomes.	A number of small-scale evaluations using a variety of approaches but limited assessment of outcomes.	A broad range of information support wanted by young people that goes beyond clinical and health needs. Pressure of school work and exams cited by young people as an issue in adherence.	Limited evidence of long-term impact from programmes either clinically or socially. The health and social care needs of young people with CKD in transition are poorly understood.
YP suffer cognitive deficits, low self-esteem, loss of independence, and loneliness.	Peer support and non-clinical mentoring trialled with some evaluation.	Peer-support and mentoring appreciated by some young people, rejected by others.	Paucity of studies and small cohorts makes evaluation difficult and therefore developing best-practice problematic.