Abstract
BackgroundCurrent status and clinical significance of interventional nephrology has not been reported from Japan.MethodsQuestionnaires were mailed twice to the directors of all 534 Japanese certificated nephrology training institutions in 2014. The main questions were current performance, categorized annual procedure volume and managers of peritoneal dialysis (PD) access, vascular access (VA) surgery, endovascular intervention, and kidney biopsy. Frequencies of nephrologist involvement between high volume center and low volume center and association between the level of nephrologists’ involvement to each procedure and annual procedure volume were examined.Results332 (62.2%) institutions answered performance of all procedures and 328 (61.4%) institutions answered all procedure volume. Kidney biopsy, VA surgery, endovascular intervention and PD access surgery were performed by any doctors in 94.2, 96.3, 88.4, and 76.2% and each involvement of nephrologist was 93.9, 54.1, 53.1 and 47.6%, respectively. Cochran–Armitage analyses demonstrated significant increases in all 4 procedure volume with greater management by nephrologists (p < 0.01). Nephrologists involvement to VA surgery associated with procedure volume increase in not only VA surgery, but also PD catheter insertion (p < 0.01) and kidney biopsy (p < 0.05). And nephrologists involvement to PD catheter insertion also associated with surgical volume increase in both VA surgery (p < 0.01) and endovascular intervention (p < 0.05).ConclusionsMain manager of all 4 procedures was nephrologist in Japan. Each procedure volume increased as nephrologists become more involved. Acquisition of one specific procedure by nephrologist associated with increase not only in this specific procedure volume, but also the other procedure volume.
Highlights
Most fellows in non-nephrology internal medicine subspecialties have never considered nephrology as a career choice and the lack of procedural opportunities may be a major reason for not selecting nephrology as a career choice [1,2,3]. ‘‘Don’t nephrologists perform any procedures?’’ medical students sometimes ask nephrologists in the United States [4], and in Japan
Main manager of all 4 procedures was nephrologist in Japan
Acquisition of one specific procedure by nephrologist associated with increase in this specific procedure volume, and the other procedure volume
Summary
Most fellows in non-nephrology internal medicine subspecialties have never considered nephrology as a career choice and the lack of procedural opportunities may be a major reason for not selecting nephrology as a career choice [1,2,3]. ‘‘Don’t nephrologists perform any procedures?’’ medical students sometimes ask nephrologists in the United States [4], and in Japan. Nephrologists are managing ordinary dialysis therapy, though various non-nephrologists are performing procedures related to nephrology around the world. This fragmentation does not optimize medical care and may be inconvenient to the patient. In 2000, the American Society of Diagnostic and Interventional Nephrology (ASDIN) was established to change the views of nephrologists regarding the practice of nephrology by promoting procedural aspects [4, 5] Responding these actions, several countries have reported on the current status of interventional nephrology [6, 7], but the exact proportions of procedures related to nephrology currently performed by nephrologists remains unclear [8]. Current status and clinical significance of interventional nephrology has not been reported from Japan
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