What? Why? How?
Vascular dialysis access is commonly proclaimed both as the “lifeline” and the “Achilles heel” for patients on dialysis. It is well established that the mechanical and infectious complications of dialysis access adversely affect patient outcomes. End-Stage Renal Disease (ESRD) costs Medicare approximately $40 billion, almost 8% of Medicare's total expenditure for only 1% of its ESRD beneficiaries.
A significant proportion of these costs were incurred by dialysis access related complications, which also accounts for a significant proportion of hospitalizations in patients with ESRD.
Today, more than 500,000 patients are on dialysis in the United States, making the issues related to ESRD care ever more challenging.
The ability to diagnose and treat patients with kidney disease requires a comprehensive approach that necessitates use of special techniques, including:
3. Thrombectomy of clotted dialysis access
4. Peritoneal dialysis catheter placement
5. Hemodialysis catheter placement: Acute and Chronic
6. Stent of venous and arterial vasculature
These unique aspects of nephrology care are not only quite technical, difficult, and intriguing, they are challenging for a general nephrologist. Traditionally, specialists other than nephrologists have rendered these procedural aspects of nephrology care, creating multiple layers of care with a complex array of somewhat disconnected providers.
The number of providers trained in Interventional Nephrology is small, and the American Board of Internal Medicine was not able to provide a separate track for its training as the number of board takers would be small. Therefore, the American Society of Diagnostic and Interventional Nephrology (ASDIN) has been spearheading the goal to provide training and oversee the certification in the field. In its fifteen tears, the society has overseen the growth in the field and provided certification requirements to standardize training.
All Interventional Nephrology faculty at LSU Health Shreveport are Nephrology American Board of Internal Medicine (ABIM) board certified and American Society of Diagnostic and Interventional Nephrology (ASDIN) Internal Medicine certified physicians.
To provide Interventional Nephrology Fellows with an organized, comprehensive, supervised, full-time educational experience in vascular interventional nephrology including the ability to provide consultation and case selection, perform the full array of vascular and interventional procedures, identify and manage potential complications, provide appropriate peri-procedure care, and assist in long-term management integrated with the clinical management of referring physicians.
Training is offered for fellows having completed Nephrology Fellowship and have a keen interest in dialysis access care of ESRD patients.
Over One Year...
the Fellow will:
- Spend 6 months in dialysis access labs under Direct Supervision of Nephrology staff certified in Interventional Nephrology
- All procedures are supervised and performed directly under the care of staff physicians
- Spend 6 months rotation in research and electives
- Pursue one or more dialysis access related research project(s) to be presented at LSU research conference and annual ASDIN meetings
- Follow ASDIN-approved curriculum for fellows in training
- Take nephrology call not exceeding one in five weekday/weekends averaged over the year
- Have one half day a week CKD clinic for the duration of training
- Establish a firm foundation of clinical knowledge and technical expertise upon which to base further personal development in the field of vascular and interventional nephrology.
- Provide a supervised, graduated clinical experience in interpreting and performing all studies encompassed by the specialty of vascular dialysis access and interventional nephrology.
- Develop familiarity with the anatomy of vascular access as applicable to vascular interventional nephrology procedures.
- Develop familiarity with the signs and symptoms of vascular access dysfunction.
- Develop an understanding of the pathophysiology and natural history of the disease processes frequently encountered in this subspecialty and the medical, surgical, and interventional radiologic treatment alternatives for these various disorders.
- Develop an understanding of common vascular interventional nephrology research methods and study design as well as common pitfalls to clinical research.
- Develop basic understanding of the indications for and the contraindications to vascular and interventional nephrology procedures listed below:
Ultrasound of Vascular access
Ultrasound of Native Kidney
Ultrasound Guided Needle Cannulation of Vein
Ultrasound guided Kidney Biopsy
Central Venous Catheter placement acute
Central Venous Catheter placement/removal chronic
Angiogram dialysis access
Angioplasty dialysis access
Thrombectomy of dialysis access
Stent of dialysis vascular access
Coil of dialysis vascular access
Dialysis access banding
Peritoneal dialysis catheter placement
Peritoneal dialysis catheter removal
For the procedures referenced:
- Learn to perform and skillfully implement the clinical and technical aspects of these procedures to maximize their safe utilization.
- Recognize and treat complications during and after vascular and interventional nephrology procedures.
- Learn to utilize the information gleaned from presentation of complicated cases at conferences to promote improved patient safety and outcomes.
- Administer and maintain effective and safe conscious sedation for patient comfort during and after vascular and interventional nephrology procedures.
- Develop a complete understanding of the fundamentals of radiation physics, radiation biology, and radiation protection as they relate to vascular interventional nephrology.
- Understand occupational hazards related to the practice of vascular interventional nephrology and learn how to avoid or minimize them.
- Develop the habit of routinely surveying the medical literature and using this knowledge in patient care. This should be done before any type of procedure or with any clinical presentation with which you are not completely familiar.
- Recognize and promote a team environment in the practice of interventional nephrology including nephrology technologists, nurses, patient care coordinators and mid level providers.
- Develop a bedside manner that is appropriate and meets the needs of the patient and provides a thorough patient assessment.
- Demonstrate a knowledge of and attitude for ethical practice.
- Log all procedures under my-evaluations within 72 hours of procedure completion
- Have consistently professional behavior and good communication skills.
- Provide appropriate patient follow-up in the inpatient and outpatient setting
Monthly evaluations will be completed by supervising faculty.
Fellows will require achievement of competency in all procedures for successful completion of the training.
Fellows will be eligible for American Society of Diagnostic and Interventional Nephrology (ASDIN) certification in hemodialysis vascular access procedures if they complete the minimum required procedures. Fellows will be responsible to monitor the numbers required for certification and maintain logs of all cases.
One-hundred twenty-five (125) procedures will have been successfully completed as primary operator in the following categories within the preceding 24 calendar months of the submission of the application for certification:
- Angiography of peripheral hemodialysis vascular access –25 cases including both grafts and fistulas
- Angioplasty of peripheral hemodialysis vascular access –25 cases including both grafts and fistulas
- Thrombolysis/thrombectomy of peripheral hemodialysis vascular access –25 cases including both grafts and fistulas
- Endovascular Stent Placement – 10 cases
- Tunneled long - term catheter procedures – 25 cases, of which at least 13 cases must be de novo placements and the remainder may be catheter exchanges.
Fellowship Application Process:
Application Deadline: March 1 (for July start)
CV, Personal Statement, 2 LORs (One from Nephrology Program Director)
Interventional Nephrology track is a one-year fellowship available to applicants after their nephrology fellowship and does not need ERAS application.
We do sponsor J-1 visa for selected applicants but are not giving any H1b visa.
All of us here at LSU Health Shreveport look forward to meeting you and helping you in your journey.
Nephrology/Interventional Nephrology - Bharat Sachdeva, MD