Starting dialysis is more than a medical event—it’s a deeply emotional, psychological, and life-altering transition. For many patients coping with chronic kidney disease (CKD), beginning dialysis marks a new chapter filled with uncertainty, vulnerability, and fear. Recognizing the immense psychological and practical challenges involved, healthcare providers are implementing specialized transitional care units (TCUs) to support patients through this critical time.

One such example is the Transitional Care Unit at Humber River Health, a dedicated six-bed unit designed to provide a soft landing for patients starting dialysis. Located at the Church Street campus, the TCU is staffed by a specialized team of nephrologists, nurses, and allied health professionals who deliver high-touch, patient-centered care over the course of a six-week program.

https://www.hrh.ca/patient-education/005038_TCU%20Guide.pdf

A Gentle Introduction to Dialysis

“Patients who are initiated [on dialysis] are experiencing a very traumatic period in their lives,” says Dr. Gavril Hercz, a nephrologist involved in the TCU program. “That brought the idea of creating a specialized small dialysis unit…with unique attributes.” Instead of thrusting patients into a busy in-center dialysis setting, the TCU provides a quieter, more personalized environment.

With a higher nurse-to-patient ratio, the unit focuses on easing patients into dialysis while simultaneously introducing them to all available treatment options, particularly home dialysis modalities. Dr. Justin Ashley, another nephrologist at Humber, explains: “We try to introduce them to other modalities, particularly home modalities including peritoneal dialysis, home hemodialysis, and home nocturnal [dialysis].”

By the end of the six-week period, patients are often able to transition either to home therapies, a transplant pathway, or into a larger in-center dialysis unit if needed—with greater confidence and reduced anxiety.

Emotional and Peer Support

Support in the TCU extends beyond physical care. Emotional wellness and psychological resilience are equally prioritized. “There’s an incredible amount of support provided by patients who are further along,” notes Dr. Hercz. “There’s nothing more powerful than peer support.” Siting the unit next to home dialysis fosters interaction with other individuals on similar journeys but further along on their care pathway. This helps normalize the experience and offers patients living proof that life continues after dialysis begins.

The TCU is also designed to foster a sense of safety and trust. “It’s a smaller environment providing patients a valuable opportunity to develop a trustworthy connection with the staff,” says Cinzia Di Carlo, a social worker with the Humber nephrology team. She highlights how the program promotes independence by asking patients, “What can you do, and how can we build on that?”

This strength-based approach empowers patients to participate actively in their care and decision-making. In doing so, it not only supports emotional well-being but helps patients maintain a sense of control—a crucial component in reducing anxiety and improving long-term outcomes.

Navigating Transitions from Hospital or Clinic

Patients enter the TCU from either an outpatient setting, such as the nephrology clinic, or an inpatient hospital setting after an acute medical episode. Dr. Shabnam Hamidi explains, “Referral to the transitional care unit will come from the nephrologist or the physician looking after the patient,” depending on where the dialysis journey begins.

This structured  transition, which includes a home dialysis coordinator,  prevents patients from falling through the cracks—a risk that is unfortunately common when patients are discharged from hospital-based care without a clear pathway forward.

Patient Voices: “They Had Me—Emotionally and Physically”

The impact of transitional care is perhaps most clearly expressed in the voices of those who’ve experienced it. One home dialysis patient recalls the emotional toll of starting treatment: “It was a lot of stress.” But her time in the TCU transformed that experience. “They had me—emotionally, physically. Every day I was sitting down thinking, ‘Relax, they are in control.’ My nurse covered everything: how to do the details with my line, everything.”

Another patient praised the comprehensive and accessible support. “I have access to a 24-hour hotline,” he said. “The nurses always helped. I can’t say anything better—you guys are great.”

The Future of Dialysis Begins with Transition

As we move toward more holistic, patient-focused models of care in nephrology, transitional units like Humber’s TCU exemplify what compassionate, integrated care looks like. By recognizing that starting dialysis is not just a clinical procedure but a deeply personal upheaval, these programs provide a supportive bridge between diagnosis and ongoing care.

Through education, emotional support, peer mentorship, and practical training, transition units prepare patients not just to survive—but to thrive—on dialysis. The ultimate goal, as Dr. Ashley notes, is to empower patients to find the modality that best fits their life, whether that’s home dialysis, transplantation, or in-center care.

In short, transitional care units are not just about beginning dialysis—they are about beginning it well. And in doing so, they give patients the best chance at a healthier, more empowered future.

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