Aspects Of Nephrology Research Articles

Current Trends and Challenges in Nephrology Fellowship Training: Expansion of Education in Home Dialysis, Palliative Care, and Point-of-Care Ultrasound.

Nephrology education has changed significantly since the first nephrology fellowship programs were established in the United States in the 1950s and 1960s. The past several years have seen increased opportunities for subspecialization in areas such as interventional nephrology, onconephrology, and glomerular disease. Notable trends in fellowship curricula include the expansion of education in home dialysis and palliative care, driven by policy changes and focus on patient-centered care. In addition, point-of-care ultrasound has garnered significant interest due to its potential to provide diagnostic information that improves patient care. An important area that remains largely unaddressed appears to be education about the business and administrative aspects of nephrology. Meanwhile, the importance of training in hemodialysis catheter placement and kidney biopsy has come into question due to the small proportion of nephrologists performing these procedures today. Nephrology fellowship programs should strive to tailor their curriculum to meet the interests and needs of individual fellows.

Chronic Kidney Disease and Malignant Neoplasms: The Current State of the Problem

Chronic kidney disease is a risk factor for other organ disease. People with kidney disease have an increased risk of developing and dying from cardiovascular disease, and there is also evidence that the risk of cancer and cancer mortality may be increased in people with chronic kidney disease. Chronic kidney disease and malignant neoplasms are interconnected in both directions: cancer can cause damage to the kidney tissue directly or indirectly through the side effects of cancer treatment. In turn, chronic kidney disease, on the contrary, can be a risk factor for the development of malignant neoplasms. In addition, both pathological processes can share common risk factors. Chronic kidney disease can result from the use of chemotherapy drugs. Many of the existing and recently developed cancer chemotherapeutic agents are nephrotoxic and can contribute to renal dysfunction, which often manifests itself in terminal cancer. To date, therapeutic interventions to combat the progressive growth of cancer can accelerate the progression of chronic kidney disease. The article provides data on the interaction of chronic kidney disease and the development of malignant neoplasms. The nephrological aspects of the clinical picture of oncological diseases are considered. The mechanisms of the negative effect on the renal tissue of anticancer drugs — cisplatin, ifosfamide, methotrexate and cyclophosphamide — are discussed. Given the link between kidney disease and the development and treatment of cancer, the review article highlights the importance of interdisciplinary collaboration between oncologists and nephrologists to predict and prevent nephrotoxic effects of cancer chemotherapy, and as new treatments for malignant neoplasms are introduced, proper diagnosis and treatment of emerging malignancies is required. new renal toxic effects.

Survey study of trends in adult nephrology advanced training in Australia and New Zealand.

There has been considerable growth in nephrology advanced trainee numbers in Australia and New Zealand, with uncertain effects on clinical experience, competence and employment outcomes. To review the perceived adequacy and temporal trends of advanced training in nephrology in Australia and New Zealand by evaluating training experiences, personal views on important aspects of training and nephrology, career paths and early employment outcomes. An online survey was distributed to members of the Australian and New Zealand Society of Nephrology through email in December 2020. Responses were sought from current trainees and from nephrologists qualifying since 2014. Likert scale proportions were calculated and group comparisons made using the Chi-squared test. A total of 88 participants returned the survey yielding a response rate of 32%, with a representative sample of trainees and consultants from across Australia and New Zealand. Training was reported as adequate in most aspects of clinical nephrology, although 88% of respondents felt poorly prepared for entering private practice and 61% reported inadequate training in kidney histopathology. Exposure to clinical procedures was variable, with adequate training in percutaneous kidney biopsy, but mostly inadequate training in dialysis access insertion. Sixty-nine percent of nephrologists completed their advanced training entirely in large urban centres and 85% worked in an urban area after training. Only 23% of consultants were engaged in full-time clinical employment in their first-year post-training and 78% were undertaking at least one of dual specialty training or a higher degree by research. Demand for subspecialty fellowships was high. Trainees and nephrologists in Australia and New Zealand are currently satisfied with their training in most aspects of nephrology; however, some clinical experiences are perceived as inadequate and early career paths after advanced training are increasingly diverse.

The changing landscape of PAs and NPs in nephrology.

Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade. Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.

The Future of Nephrology and Public Health.

The study of kidney diseases has been described since the Hippocratic era, but nephrology as a medical specialty dates from the mid-20th century. Despite all interesting aspects of nephrology, there is a lack of interest by young physicians for the specialty worldwide. Great discoveries have been made throughout the years, leading to great achievements in diagnosis, classification, and treatment of kidney diseases. There is a current interest in the search for novel biomarkers for early detection of kidney dysfunction, and, in the future, there will be novel diagnostic tests for kidney diseases. There have been significant improvements in dialysis and transplant techniques, and novel modalities are being studied, including new renal replacement therapy modalities, such as the wearable artificial kidney. Another trend in the contemporary world, and one that should increase in the future, is the increasing patient connectivity, using novel technologies that will allow access to healthcare and improve outcomes.

The changing landscape of nephrology physician assistants and nurse practitioners.

Physician assistants (PAs) and nurse practitioners (NPs) have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. To evaluate workforce patterns of PAs and NPs working in nephrology over the past decade. Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. Surveys of nephrology practitioners show the evolution of the dialysis-centralized practitioner to one encompassing all aspects of nephrology: hospital, intensive care unit, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. Physician assistants and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.

Nephrological Aspects of Balneotherapy with Uvinskaya Mineral Water in Patients with Type 2 Diаbetes

Aim.The present article studies the effect of balneotherapy with Uvinskaya mineral water on the microbial spectrum of urine in patients with type 2 diabetes.Materials and methods.The study was carried out at the Endocrinology Department of the First Republican Clinical Hospital (Izhevsk). A total of 56 patients with type 2 diabetes participated in the study, which involved collecting medical history and complaint data of patients along with performing general and system-based examination, urinalysis, urine culture prior to and following the course of therapy, as well as kidney ultrasound aimed at excluding the presence of calculi. Urine cultures (morning sample) were plated onto 5% blood agar, as well as Endo’s medium for detecting bacteria from theEnterobacteriaceaefamily using the Gould method. Urine cultures were incubated for 24, 72 and 144 hours at a temperature of 37 °C. The significance of differences was determined using the t-test for independent and paired samples.Results.Changes in urinalysis were observed in all examined patients, which included changes characteristic of urinary tract infections: a large number of bacteria per field of view; a large amount of mucus; the presence of leukocytes in urine; alkaline pH shift; as well as disorders typical of diabetes mellitus (glycosuria, proteinuria).E. colipredominated in urine cultures. Following a 30-day therapy with Uvinskaya mineral water, the number of bacteria and leukocytes, as well as the amount of mucus, detected in the urine reduced significantly, which indicates urinary tract sanation. Positive dynamics among patients who underwent balneotherapy treatment is confirmed by the Student’s t-test (p < 0.05). In addition, no urinary sanation was observed in the group of patients who did not receive balneotherapy.Conclusion.Drawing on the study results, the authors recommend using Uvinskaya natural mineral water in the combined treatment of patients with type 2 diabetes for urinary tract rehabilitation.

The Nephrological Aspects of the Use of Rivaroxaban and Other Direct Peroral Anticoagulants in Non-Valvular Atrial Fibrillation

Chronic kidney disease (CKD) is a powerful cardiovascular risk factor, its presence is accompanied by an increased risk of hospitalization for exacerbation of chronic heart failure (CHF), adverse outcomes in myocardial infarction, and cardiovascular mortality. Among the adverse events, an increased risk of atrial fibrillation (AF) should be noted. This article contains discussion of current approaches to the treatment of AF in patients with different stages of CKD, data on benefits of certain direct oral anticoagulants, as well as comparative characteristics of therapy with direct oral anticoagulants and warfarin. Pharmacokinetics and pharmacodynamics of direct oral anticoagulants, which determine the features of therapy in CKD, are also considered.

Nephrological aspects of surgical weight correction in morbid obesity.

Obesity, including morbid obesity, is a growing worldwide problem. The adverse effect of obesity on the kidneys is associated with the development of comorbid conditions, such as insulin resistance (IR), metabolic syndrome (MS), diabetes mellitus (DM), arterial hypertension (AH), which are the recognized risk factors of chronic kidney disease (СKD). Obesity also causes direct kidney damage with the development of non-immune focal segmental glomerulosclerosis. The leading pathophysiological mechanisms of kidney damage in obesity are intrarenal hemodynamic disorders with the formation of hyperfiltration and damaging effects of adipokines produced by adipose tissue. Bariatric surgery (BS) has taken a leading position in the treatment of morbid obesity, demonstrating its effectiveness not only in long-term weight loss, but also in the correction of IR, MS, DM, AH. Nephroprotective effect of significant and persistent weight loss is caused by the elimination of hyperfiltration and damaging effect of adipokines. Results of the observational studies of the immediate and long-term effects of BS have demonstrated positive renal outcomes, in particular, the decrease in albuminuria/proteinuria, the improvement or stabilization of glomerular filtration rate, the delay of end-stage renal failure development; surgical correction of body weight in dialysis patients with morbid obesity lets them realize subsequent kidney transplantation. Large, randomized prospective studies with a longer follow-up are needed; analysis of the long-term renal consequences of BS in obesity patients with pre-existing renal impairment, including dialysis patients, is required; stratification of the BS risk of renal complications (acute kidney damage, nephrolithiasis, nephrocalcinosis) and effective strategy for managing these risks need to be developed.

Peritoneal dialysis education: Challenges and innovation.

Peritoneal dialysis is the most common modality for home dialysis and to ensure patients have access to dialysis at home, training programs have to ensure that the fellows attain clinical competency in the care of such patients. The limited data available however are sobering; about 10 years ago, 44% of nephrologists reported that they did not feel competent in the care of patients undergoing peritoneal dialysis. There are recognizable challenges in ensuring clinical competency of trainees that may need creative solutions. It is important for training program directors to evaluate the state of training at their institution, identify their unique barriers, and work to overcome them in the interest of ensuring that fellows are trained in all aspects of nephrology.

Nephrological aspects of complement-mediated thrombotic microangiopathy

To analyze cases of complement-mediated thrombotic microangiopathy (C-TMA) in the daily practice of a hospital nephrology department, relative to the general aspects of the clinical course, therapy, and short-term outcomes. The prospective study conducted in the period June 1, 2015 to June 1, 2016 included 10 patients with C-TMA newly diagnosed during hospitalization. Standard demographic parameters, generally accepted clinical data showing the severity of TMA and the involvement of vital organs were recorded at admission. Short-term outcomes of therapy (plasma therapy and/or eculizumab therapy), such as achievement of hematological remission and the need for maintenance therapy and renal replacement therapy (RRT), were evaluate. The median time from the onset of symptoms of the disease to diagnosis in the analyzed cases was 5 months (range 1 week to 26 months). The incidence of C-TMA among the inpatients of nephrology departments was 6.4 per 1,000 patients per year. Five patients were admitted to a clinic with symptoms of obvious extrarenal organ disorders; 4 of them had multiple organ dysfunction. Evident clinical symptoms of renal dysfunction were detected in all the patients, which necessitated RRT in 8 out of the 10 patients. Renal biopsy was performed in 7 patients. All were found to have typical morphological manifestations of acute and chronic TMA. All the patients received plasma therapy; most of them had plasma exchanges; 4 patients took eculizumab. There were no fatal outcomes. All achieved hematological remission. Three of the 8 cases could achieve varying recovery of kidney function and stop dialysis. Analysis of this series of cases confirms the idea about the severity of TMA due to multiple organ dysfunction and the high risk of end-stage renal failure at late diagnosis. The key points of better renal prognosis are the earliest detection and treatment of the disease.

Transplant Surgeon Meets Nephrologist: Important Nephrological Aspects Before and After Kidney or Liver Transplantation

In cases of chronic renal insufficiency, successful kidney transplantation is the method of choice to restore patients' health, well-being and physical fitness. The interdisciplinary collaboration of nephrologists and transplant surgeons has always been a prerequisite for the successful pre-, peri- and post-transplant care of renal transplant patients. The same holds true for liver transplant patients. Here the nephrologist is often involved in cases requiring pre- or post-transplant dialysis as well as in decision making for combined liver-kidney transplantation. This review focuses on nephrological aspects in patient care before and after kidney and liver transplantation.

US Nephrology Workforce Crisis: Our Specialty Must Stay Modern and Relevant

Interest in nephrology as a career choice for physicians in the United States continues to decline, particularly among US medical graduates. Reasons for this are multi-factorial and include nephrology being perceived as difficult, arduous and un-inspiring with poor career prospects. This short paper discusses some aspects of Nephrology that need to be adjusted to attract bright enthusiastic physicians who can move the specialty forward.

Public health aspects of nephrology, dialysis and kidney transplantation in bosnia and herzegovina.

It is my great pleasure to introduce to you this special issue of the journal Materia Socio-Medica on the occasion of the 4th Congress of Nephrology of Bosnia and Herzegovina with international participation that will be held in Sarajevo from 22nd to 25th April 2015. The Association of Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina has organized congress under the auspices of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) and the International Society of Nephrology (ISN). This scientific meeting covers the most recent discoveries in the fields of acute kidney injury, chronic kidney disease, cardiovascular diseases, hypertension, diabetes mellitus, dialysis and kidney transplantation. Gathering a large number of national and international nephrologists as well as many distinguished international speakers will certainly contribute to the knowledge transferring and quality of this meeting. There will be more than 200 participants, submitted presentations from more than 20 countries.

Raymond Vanholder: a titan of uraemic toxicity

Raymond Vanholder: a titan of uraemic toxicity

Increase in nephrology advanced trainee numbers in Australia and associated reduction in clinical exposure over the past decade

Advanced training in nephrology should provide broad experience in all aspects of nephrology. In Australia, the Specialist Advisory Committee in Nephrology oversees nephrology training, and recent increases in advanced trainee numbers have led to concern about dilution of training experience. No study has examined variations in clinical exposure for nephrology trainees in Australia. To assess the changes in nephrology advanced training in Australia with respect to trainee numbers and exposure to patients and procedures over the past 10 years. A retrospective study was performed by obtaining all available Royal Australasian College of Physician supervisor reports from 2000 to 2010 to determine differences in clinical exposure and procedures performed by nephrology trainees. Five hundred and forty-two reports were reviewed involving 208 nephrology trainees in Australia across 53 different training sites. In 2000, 22 trainees were undertaking a core clinical year of training. Trainee numbers have steadily risen from 33 in 2004 to 84 in 2010. The greatest increases have occurred in New South Wales, Victoria and Queensland (sixfold, threefold and fivefold increases respectively). Trainee exposure to dialysis patients has gradually decreased in the past decade. The average number per trainee per year in 2000 compared with 2010 were 66 versus 43 (P = 0.02) and 28 versus 16 (P = 0.01) for haemodialysis and peritoneal dialysis respectively. Acute kidney injury cases per trainee showed a gradual nonsignificant reduction over time and average procedural numbers per trainee decreased significantly from 2000 to 2010 with fewer temporary dialysis catheters inserted per year (39 vs 10, P < 0.01) and fewer renal biopsies performed per year (65 vs 41, P < 0.01). The proportion of trainees working in a hospital that does not provide exposure to acute transplantation has steadily increased from 15% in 2003 to 44% in 2010. There has been a dramatic and significant increase in nephrology advanced trainee numbers over the past decade at a more rapid rate than the growth in dialysis and transplant patient numbers. This study suggests that training experience has diminished over the past decade and supports a 3-year core clinical nephrology training programme in Australia.

Preface

2012 has been an interesting and important year, both for this journal and for the International Society for Hemodialysis (ISHD). During July we received the journal's impact factor for 2011. This was 1.543, up by 0.45 from our first ever impact factor of 1.093 in 2010. Hemodialysis International is included in the 73 journals listed under Urology and Nephrology and is ranked 43rd out of 73 journals in 2011, up from 55th in 2010. Looking only at nephrology-related journals, in 2011 we were 23rd out of 37 journals as compared with 30th out of 36 in 2010. This is very good news. Remember, as we only publish four issues a year we will never be able to compete with the major journals like JASN, KI, AJKD, CJASN, and NDT that are published monthly. The number of submissions to the journal has been increasing over the years and as a result, the acceptance rate has fallen from 51% in 2011 to 33% in the first 10 months of 2012. Manuscripts have been received from 42 different countries. The United States and Turkey continue to be the countries providing the largest number of manuscripts and account for 25% of all original submissions; China, Iran, Italy, Korea, Brazil, Taiwan and Canada together make up a combined 37% of the submissions. As a result of these successes consideration is being given to expanding the journal. With regard to the ISHD, Dr. Madhukar Misra has been reelected as president for a further three years commencing in 2013. One of the major events in 2012 was the first ISHD hemodialysis educational seminar in Chicago in September 2012 organized by Dr. John Daugirdas and Dr. Misra. This attracted more than 110 attendees, including physicians, nurses and allied medical personnel. The format used interactive seminars rather than didactic lectures and the proceedings were video recorded. The edited recording will be made available on the ISHD website. The initial response of the attendees to the course was very favorable and as a result of the success of the seminar it has been decided to register and formally copyright the term “Hemodialysis University” for this course. Continuing medical education (CME) accreditation was obtained for physicians, nurses and allied medical personnel. It is proposed to hold future “Hemodialysis University” courses and to develop a core curriculum which would then permit accreditation by distance learning by allowing review of the educational material made available on the ISHD website in conjunction with an examination. The next Hemodialysis University will be held in Shanghai by Zhongshan Hospital Department of Nephrology, Fudan University, and the International Society for Hemodialysis, March 31—April 1, 2013. It will focus on clinically important problems in dialysis—RRT in AKI, blood pressure, infection control, hemodialysis adequacy, complications, vascular access, water treatment and is designed for nephrologists, nephrology fellows, nephrology nurses and nurse practitioners, Check the ISHD website. The Vth International Congress of the ISHD was held in Taipei, Taiwan, in August 2012, presided over by Dr. Hung Chun Chen. This was a very successful meeting despite a visit from typhoon Saola and attracted some 1,000 attendees. The next, the VIth International Congress of the ISHD will be held jointly with the XVIIIth Argentine Congress of Nephrology and the XIth Argentine Congress of Nephrology Nurses from the 11th – 14th September, 2013, in Buenos Aires. The meeting will focus on cardiac and metabolic disorders in hemodialysis. Details of this meeting can be found in this copy of the journal and http://www.ishd-can2013.com.ar/. The Argentine Society of Nephrology is one of the major such organizations in Latin America. Proposals have been received for the VIIth and VIIIth International Congresses in 2014 and 2015 respectively. By this time the annual Vicenza courses on various aspects of nephrology are well known. This year the 31st International Vicenza Course on Critical Care Nephrology will be held in Andrea Palladio from June 11–14, 2013. For more details, go to VicenzaNephroCourses.com. Remember, World Kidney Day is March 13, 2013. To learn more about the International Society for Hemodialysis, its meetings, and how to join the society log on to http://ishd.net/

Share of Females in Nephrology of Iran

Introduction: Iran located in Southern, Western part of Asia(Middle East), with the Gross Domestic Product (GDP) per capita of 4,500USD and 75 million population, is among middle income countries. 24% are younger than 15 years and the median age is 26.7 years, which means a serious competition through National Entrance Examination for universities. Currently,60% of those who pass the entrance exam of universities in medical fields are female. Historically in Iran as many other parts of the world, women's participation in practice of medicine has been significantly restricted. Access to medical education in Iran was achieved by women with effort to win the competition which continued through higher educational levels of specialties and subspecialties. According to the MOH an internal medicine specialist with board certificate can apply for entrance exam of nephrology fellowship. Afterward, if he or she pass the final national board exam, he/she gets subspecialty certificate which ensure academic employment opportunities. As the number of nephrologists all over the country is low yet, they are all involved in different aspects of nephrology; general nephrology, transplantation and dialysis. Methods: The data of all participants of nephrology fellowship and the results of its board exam in MOH from 1990-2011 was reviewed. Results: As the figures show, whereas the absolute number of nephrologists increased from less than 25 in 1990 to 100 in 2000 and 200 in 2011, the 4% share of females increased to 26% and 37% respectively. Further investigation in female medical specialists’ perspective of their objectives of further qualification, intentions, and how they managed extra family commitment in addition to establishing a practice would be more informative for role modeling for future generations.Figure: [number of nephrologists from 1991-2011]Figure: [Sex Percentage of nephrology(1991-2011)]

Factors in Career Choice among US Nephrologists

There is a projected shortage of kidney specialists, and retention of trainees in nephrology is important. Determining factors that result in choosing a nephrology career could inform future strategies to attract nephrology fellows. An anonymous, internet-based survey was sent to members of the American Society of Nephrology in June 2009. Respondents answered questions about demographics, training background, and career choices. Of the 3399 members, 913 (23%) returned the survey. Mean age was 51.1 ± 10.5 years, and 46.1% were academic nephrologists. In addition, 38.4% of respondents graduated between 2000 and 2009. Interest in nephrology began early in training, with the intellectual aspects of nephrology, early mentoring, and participation in nephrology electives named as the most common reasons in choosing nephrology. Academic nephrologists were more likely to have participated in research in medical school, have a master's degree or PhD, and successfully obtained research funding during training. Academic debt was higher among nonacademic nephrologists. Research opportunities and intellectual stimulation were the main factors for academic nephrologists when choosing their first postfellowship positions, whereas geographic location and work-life balance were foremost for nonacademic nephrologists. These findings highlight the importance of exposing medical students and residents to nephrology early in their careers through involvement in research, electives, and positive mentoring. Further work is needed to develop and implement effective strategies, including increasing early exposure to nephrology in preclinical and clinical years, as well as encouraging participation in research, in order to attract future nephrology trainees.

Exciting times for renal medicine

On March 11, 2010, nephrologists and patients all over the world participated in the yearly World Kidney Day—an initiative to raise awareness of the importance of our kidneys for overall health. On March 13–17, the 2010 spring clinical meetings of the National Kidney Foundation took place in Orlando, FL, USA, which presented a unique opportunity to learn about new aspects of nephrology.