Nephrology Program Research Articles

Nephrology Program Director and Fellow Home Hemodialysis (HHD) Curriculum Survey

Nephrology Program Director and Fellow Home Hemodialysis (HHD) Curriculum Survey

Safety and Diagnostic Yield of Kidney Transplant Biopsies in an Interventional Nephrology Program: A Retrospective Single-Center Study

Safety and Diagnostic Yield of Kidney Transplant Biopsies in an Interventional Nephrology Program: A Retrospective Single-Center Study

The Landscape of Pediatric Acute Care Nephrology Programs

The Landscape of Pediatric Acute Care Nephrology Programs

A National Survey of Pregnancy and Parenthood among Nephrology Trainees: A Focus on Nephrology Fellowship.

National and international policies on parental leave for physician trainees are inconsistent. Physician trainees, including nephrology fellows, may be at higher risk of pregnancy complications. Physician trainees face barriers in meeting their breastfeeding goals and in finding childcare due to nontraditional work hours with extended or unpredictable shifts. Here, we examine awareness of current policies in United States (US) nephrology fellowship programs regarding parental leave, pregnancy/breastfeeding accommodations, and fellows' perspectives on family planning. An anonymous, on-line survey of US nephrology fellows was undertaken from June 9 to August, 24, 2023. One hundred twenty nephrology fellows submitted the survey. A majority of fellow respondents were unaware of parental leave policies of their training programs (63%), Accreditation Council for Graduate Medical Education (ACGME) (75%), and/or American Board of Medical Specialties(ABMS) (75%). Forty two percent were unaware of the duration of parental leave at their program. Nearly 45% of all respondents were unsure if their program limited night shifts or shifts greater than 24 hours for pregnant trainees. Forty three percent reported they were unsure of lactation accommodations, and 40% were unsure of access to subsidized childcare. When fellows received work accommodations for pregnancy or parenthood, their work obligations were largely covered by co-fellows (60%) or attendings (38%). Over 60% of fellows agreed or strongly agreed that they would avoid a pregnancy in fellowship due to concern they would have to extend their training. Of the 40 fellows who chose to pursue pregnancy or parenthood during medical training, 75% did not change their career plans as a result. Most nephrology fellows were unaware of parental leave policies and pregnancy/lactation accommodations. While the topic itself has a broad impact to all physician trainees, there is need for improved awareness about national and local program policies among trainees across individual nephrology programs.

Protected Time for Program Administration among Nephrology Program Leadership in the United States.

In 2022, the Accreditation Council for Graduate Medical Education reduced minimum program director protected time for program administration from 10 to 8 h/wk, with no core faculty requirement. We surveyed program leaders regarding the effect of these changes. This is an anonymous, online survey of all US adult nephrology program directors (March 2023), who forwarded core faculty/associate program director (APD) surveys. The questions included protected time in 2022-2023 and 2021-2022, whether it was sufficient, estimated time needed, and two validated single-item burnout measures (emotional exhaustion and depersonalization). The analysis was descriptive. Program directors: Their response was 62% (92/149), with geographic distribution/approved fellow positions similar to those nationally. Overall, protected time slightly increased from 2021 to 2022, largely in >6-fellow programs, but 42% (13/31) of these were still not meeting minimum requirements. Only 37% (30/81) agreed that they had sufficient protected time. Those with ≤6 fellows estimated needing 11±4 h/wk (15±4 h/wk with >6 fellows). Twenty-five percent (20/81) reported high levels of emotional exhaustion. Core faculty: 57 of 149 program directors (38%) forwarded the link to 454 faculty. Ninety-four percent of APDs (49/52) responded, reported 3±3 h/wk protected time (42% had none), and estimated needing 6±3 h/wk, regardless of program size. Sixty-seven of 402 core faculty (17%) responded, reported 2±3 h/wk (50% had none), and estimated needing 5±3 h/wk, regardless of program size. ≥85% of APDs and core faculty precepted clinical rotations, gave lectures, evaluated fellows, mentored scholarly work, and participated in recruitment. The majority assisted in fellow remediation. Thirty-four percent (15/44) of APDs and 21% (13/61) of core faculty reported high levels of emotional exhaustion. Program leaders estimated minimum necessary program administration times (on the basis of program size) that exceeded the Accreditation Council for Graduate Medical Education requirements. APDs/core faculty contributed substantially to nonclinical training. Thirty-four percent of APDs and 25% of program directors had a high likelihood of burnout.

"Weighing the Pros and Cons of Everything": A Qualitative Descriptive Study Exploring Perspectives About Living Donor Kidney Transplantation From Parents of Chinese Canadian Pediatric Patients With Chronic Kidney Disease.

As of 2021, more than 6000 children and youth in Canada were living with end-stage kidney disease (ESKD), for which kidney transplantation is considered the preferred treatment by health professionals. Research shows that living donor kidney transplantation (LDKT) has superior allograft and recipient survival compared to deceased donor kidney transplantation (DDKT). However, in a pediatric setting, the choice of LDKT or DDKT is a summative consideration of factors weighed carefully by the patient's family, health care team, and patient. Decision-making surrounding transplantation may be more complex for racial and ethnic minorities as culturally specific values and beliefs are interwoven within dominant understandings and concepts of health and accepted models of health care. For example, Chinese Canadians have an increased risk of ESKD, yet reduced access to LDKT compared to White patients, despite being the largest visible minority population in Canada. The objective of this qualitative study is to deepen our understandings of the decision-making process surrounding DDKT versus LDKT among parents of Chinese Canadian pediatric patients with chronic kidney disease (CKD). Qualitative descriptive study design. The Nephrology Program at The Hospital for Sick Children in Toronto, Canada. Caregivers of Chinese Canadian patients with CKD, 18 years of age or older, and who spoke English, Cantonese, or Mandarin. One-on-one, semistructured interviews were conducted virtually, by a member of the research team and were audio-recorded and transcribed verbatim. Thematic analysis was used to explore participants' shared experience. Seven interviews were conducted with 6 mothers and 1 father of 6 Chinese Canadian pediatric patients with CKD: 4 patients had undergone a kidney transplant, and 2 were not yet listed for transplant. Analysis of data highlighted that cultural influences affected whether parents shared with others about their child's illness and experience. The cultural understanding that it is inappropriate to burden others contributed to the creation of an isolating experience for participants. Cultural influences also impacted whether parents asked others to be a living donor as participants articulated this would place a physical burden on the living donor (e.g., potential risk to their health) and an emotional burden on the participant as they would be indebted to a willing donor. Ultimately, parents' decision to choose DDKT or LDKT for their patient-child was a result of evaluating both options carefully and within an understanding that the ideal treatment choice reflected what was best for all family members. Findings reflect experiences of a small sample from a single recruitment site which may limit transferability. Parents in this study felt that they had access to the necessary evidence-based information to make an informed decision about the choice of DDKT versus LDKT for their child. Participant narratives described feeling isolated within cultural communities of family and friends and participants' suggestion of benefiting from increased support may guide future research directions. Practitioners can offer direct and indirect support to families, with recognition of the importance of cultural values and family-centered care on decision-making within families. Opportunities are needed for accessible, virtual social support platforms to increase parental feelings of culturally mediated peer support from parents who share similar experiences.

Advances in Hemodialysis in the Last Decade in Latin America.

Kidney replacement therapy (KRT) initiated in Latin America towards the second half of the 20th century, starting with dialytic therapies and, shortly thereafter, with kidney transplant. By the end of 2021, close to half a million Latin Americans were under KRT, with an overall unadjusted prevalence of 872 per million persons (pmp), yet with significant heterogeneity between nations. By treatment modality, 68% of prevalent patients were treated with hemodialysis (HD), 9% with peritoneal dialysis (PD), and 23% were living with a functioning kidney graft (LFG). In the last decade, HD is the KRT that has had the largest growth, and it also has incorporated newer and better technologies. Nevertheless, Latin America shows heterogeneity between countries, and as a region we are far from achieving full accessibility to all in need of KRT. While there has been growth and improvement in existing renal dialysis registries, and several countries that did not previously have these registries have implemented them, there are still some nations with limited or absent registry implementation. The number of nephrologists in the region is heterogeneous, with only four countries having an appropriate group of specialists. The remaining nations have an important need to expand nephrology training programs. SLANH is a major regional player in addressing these topics and supporting the expansion of appropriate nephrology programs to improve inequalities and patient care. (Rev Invest Clin. 2023;75(6):300-8).

Implementing a Supportive Information System for the Vaccination Program of CKD Patients: Project from the Regional Nephrology Program, Military Hospitals, Taif Region, Saudi Arabia

Implementing a Supportive Information System for the Vaccination Program of CKD Patients: Project from the Regional Nephrology Program, Military Hospitals, Taif Region, Saudi Arabia

Nephrology Program Director Protected Time for Training Program Administration: A Follow-Up Survey

Nephrology Program Director Protected Time for Training Program Administration: A Follow-Up Survey

Results and Economic Benefits of the Implementation of an Interventional Nephrology Program in a Third-Level Center in Mexico City

Results and Economic Benefits of the Implementation of an Interventional Nephrology Program in a Third-Level Center in Mexico City

Perception of Nephrology residency training in Peru

IntroductionIn the assessment of the second specialty training programs, the opinion of residents and graduates is essential to know the degree of satisfaction with the training received. The aimed was to assess the perceptions of Peruvian nephrology residents and graduates regarding their training. MaterialA descriptive, cross-sectional study included all final-year residents and graduates of the nephrology program in 2022. An anonymous virtual survey assessed sociodemographic aspects, nephrology tutoring, clinical training, external rotations, research, the impact of the COVID-19 pandemic, and overall perception of their training. ResultsWith a response rate of 79.68%, 51 participants were evaluated. 76.48% of the participants rated their overall training during the residency as good. 58% agreed or strongly agreed that their tutor's performance was good. 66.6% agreed or strongly agreed that their theoretical training was good, with less certainty in genetic kidney diseases. 90% agreed or strongly agreed that their practical training was good, with less certainty in training in slow therapies, renal biopsies, acute peritoneal dialysis, and peritoneal dialysis catheter placement. 80.4% agreed or strongly agreed that the pandemic affected their training. The general perception had a positive correlation with the tutor's performance as good (r=0.50; P<.001), the good perception of the hospital's research level (r=0.47, P<.001), and the perception of good opportunities to get a job as a nephrologist (r=0.67, P<.001). ConclusionAlthough, in general, the perception is positive, there are aspects in which the training of Peruvian nephrology residents should be improved.

#4753 TELEDIALYSIS: THE FIRST NORTHEAST ITALY EXPERIENCE OF TELEHEALTH IN PERITONEAL DIALYIS PATIENTS

Abstract Background and Aims During Covid19 epidemic, International Society of Peritoneal Dialysis recommend “ People on PD should stay at home. Hospital visits should be minimized for only urgent indications. Consultations should otherwise be conducted by telehealth”. In 2021 in Italy Government enforce plan to develop Telehealth and to create a new Nephrology home model to provide better oversight of care with remote monitoring.Telehealth has been used to manage patients with chronic kidney disease (CKD) and demonstrated equal outcomes in CKD care by either in-person or virtual visits. Telehealth also help facilitate patient education about home dialysis modalities and self-care, especially in peritoneal dialysis setting (PD). We report the first experience in the Northeast of Italy with Teledialysis, a combination of PD technique and new technology devices that we used together to overcome clinical, social and psychological barriers to PD. Method In our pilot study, we enrolled 12 consecutive Automated Peritoneal Dialysis (APD) patients from our Nephrology program in “San Bassiano Hospital”, Bassano del Grappa, Vi, Italy. Teledialysis was perform with the combination of two systems: 1- A Web platform Sharesource (Baxter Renal care ®) that with a mod-M added to APD device supports remote patient management through secure communication with can allows details of the home dialysis treatment and provide to the clinician the ability to act on that assessment by updating the patient device setting to the cycler. 2-Totem eVISUS System (TesiSquare®) that is a plug and play system consisting of two units: a) a transportable remote station at the patient's home (Totem) equipped with high performance camera, touchscreen monitor, speaker microphone hand free and computers, internet routers for fixed and mobile phone, wireless access point and remote control to answer calls remotely and b) a Control Station (in our Hospital) that by a simple use of a mouse form our healthcare personnel can connect to one or more patients at the same time and check the Totem Camera. (Figure 1) Figure 1:The Teledialysis System: 1) Sharesource for remote control; 2) Totem at home access point with remote control. 3) Central station in the hospital for virtual evaluation. We control day by day PD sessions by sharesource and we provide virtual support to our patients for medications of catheter exit-site and catheter exit-site monitoring and instructions for PD training; we also perform clinical evaluation status, we check PD effluent color and we aid patients and care givers for PD session management. Results During an observation period of 11 months we enrolled 12 consecutive patients (4m/8F) with an average age of 73 yrs; cognitive impairment, diabetes, hypertension, chronic heart failure and peripheral vascular disease (PVD) were common comorbidities (see Figure 2). Figure 2:Characteristcs of the patients. We perform 60 teledialysis sessions with an average duration of 26’ minutes. We don’t detect any exit Site Infection (ESI), Tunnel infection or Peritonits in our population; none of our patients require urgently hospital or emergency room admission. Only once we suggest access to our department for fever and dyspnea and the patient require a one week hospitalization for acute bacterial pneumonia. (Table 1) Conclusion Our preliminary results shown that Teledialysis is a safe, reliable, flexible and effective system and is easy to use for our patients; we assert that technology really can help nephrologist to improve PD program and aid patients to overcome barriers to select PD and avoid fear of the failure. Teledialysis promote a real integration between Hospital and our territory by a new care pathway.

Trends in the representation of women in the American Society of Pediatric Nephrology program at the Pediatric Academic Society annual meetings 2012-2021.

Women are under-represented in virtually all fields of academic medicine. Even in pediatrics, a field that historically attracts a workforce with a majority of women physicians, substantial gender disparities persist in leadership positions. However, previous studies of gender representation in various academic settings are limited to small studies or aggregate pediatric subspecialties, thereby omitting important granularity within each subspecialty. No prior studies have investigated potential gender disparities in pediatric nephrology. The aim of this study is to determine the representation of women physicians in leadership and speaking roles in the annual American Society of Pediatric Nephrology (ASPN) meeting. Data were analyzed from the 2012-2022 ASPN annual scientific meetings at the Pediatric Academic Society (PAS). Data were abstracted regarding gender and roles: speaker, chair/moderator, and lifetime achievement awardee. We performed a time series analysis using linear regression, with the year as the independent variable and the proportion of women as the dependent variable. Overall, there were statistically significant increases in the proportion of women speakers per year and percentage of women chairs or moderators. There were no specific trends noted for lifetime achievement awards and no statistically significant changes in the number of lifetime achievement awards. We found proportionate representations of gender representation with regards to speakers and chairs or moderators, although our data was limited by comparison to the American Board of Pediatrics (ABP) workforce cumulative "ever certified" data. The ABP data include a disproportionate representation of faculty who are men from earlier certification periods who may no longer be actively practicing pediatric nephrology.

Point-of-Care Ultrasound Use in Nephrology: A Survey of Nephrology Program Directors, Fellows, and Fellowship Graduates.

Adoption of point-of-care ultrasound (POCUS) into nephrology practice has been relatively slow. We surveyed US nephrology program directors, their fellows, and graduates from a single training program regarding current/planned POCUS training, clinical use, and barriers to training and use. Anonymous, online survey. All US nephrology program directors (n=151), their fellows (academic year 2021-2022), and 89/90 graduates (1980-2021) of the Walter Reed Nephrology Program. Descriptive. 46% (69/151) of program directors and 33% (118/361) of their fellows responded. Response rate was 62% (55/89) for Walter Reed graduates. 51% of program directors offered POCUS training, most commonly bedside training in non-POCUS oriented rotations (71%), didactic lectures (68%), and simulation (43%). 46% of fellows reported receiving POCUS training, but of these, many reported not being sufficiently trained/not confident in kidney (56%), bladder (50%), and inferior vena cava assessment (46%). Common barriers to training reported by program directors were not enough trained faculty (78%), themselves not being sufficiently trained (55%), and equipment expense (51%). 64% of program directors and 55% of fellows reported<10% of faculty were able to perform POCUS. 64% of fellows reported having too little POCUS training. 72% of program directors and 77% of graduates felt POCUS should be incorporated into the fellowship curriculum. 59% of fellows and 61% of graduates desired hands-on POCUS training rather than didactic lectures or simulation. Loss of respondents as program directors and fellows progressed through the survey. Nephrology program directors, fellows, and graduates surveyed want POCUS training incorporated into the fellowship curriculum. No group felt sufficiently trained to confidently perform POCUS, and the major barrier to training was lack of sufficiently trained faculty. This highlights the need to "train the trainers" before POCUS can be fully integrated into fellowship training and regularly used in nephrology practice.

Home Dialysis Training Needs for Fellows: A Survey of Nephrology Program Directors and Division Chiefs in the United States

Home Dialysis Training Needs for Fellows: A Survey of Nephrology Program Directors and Division Chiefs in the United States

Patient-Reported Outcomes Over 24 Months in Pediatric CKD: Findings From the MyKidneyHealth Cohort Study

The lived experience of children with chronic kidney disease (CKD) is poorly characterized. We examined the associations between patient-reported outcome (PRO) scores measuring their fatigue, sleep health, psychological distress, family relationships, and global health with clinical outcomes over time in children, adolescents, and younger adults with CKD and investigated how the PRO scores of this group compare with those of other children, adolescents, and younger adults. Prospective cohort study. 212 children, adolescentss, and adults aged 8 to 21 years with CKD and their parents recruited from 16 nephrology programs across North America. CKD stage, disease etiology, and sociodemographic and clinical variables. PRO scores over 2 years. We compared PRO scores in the CKD sample with a nationally representative general pediatric population (ages 8 to 17 years). Change of PROs over time and association of sociodemographic and clinical variables with PROs were assessed using multivariable regression models. For all time points, 84% of the parents and 77% of the children, adolescents, and younger adults completed PRO surveys . The baseline PRO scores for the participants with CKD revealed a higher burden of fatigue, sleep-related impairment, psychological distress, impaired global health, and poorer family relationships compared with the general pediatric population, with median score differences≥1 SD for fatigue and global health. The baseline PRO scores did not differ by CKD stage or glomerular versus nonglomerular etiology. Over 2 years, PROs were stable with a<1-point annual change on average on each measure and intraclass correlation coefficients ranging from 0.53 to 0.79, indicating high stability. Hospitalization and parent-reported sleep problems were associated with worse fatigue, psychological health, and global health scores (all P<0.04). We were unable to assess responsiveness to change with dialysis or transplant. Children with CKD experience a high yet stable burden of impairment across numerous PRO measures, especially fatigue and global health, independent of disease severity. These findings underscore the importance of assessing PROs, including fatigue and sleep measures, in this vulnerable population. Children with chronic kidney disease (CKD) have many treatment demands and experience many systemic effects. How CKD impacts the daily life of a child is poorly understood. We surveyed 212 children, adolescents, and younger adults with CKD and their parents over 24 months to assess the participants' well-being over time. Among children, adolescents, and younger adults with CKD we found a very high and persistent burden of psychological distress that did not differ by degree of CKD or type of kidney disease. The participants with CKD endorsed greater impairment in fatigue and global health compared with healthy children, adolescents, and younger adults, and parent-reported sleep problems were associated with poorer patient-reported outcome (PRO) scores across all domains. These findings emphasize the importance of including PRO measures, including fatigue and sleep measures, into routine clinical care to optimize the lived experience of children with CKD.

Evaluating Home Dialysis Training Requirements: A Survey of Nephrology Program Directors and Division Chiefs

Evaluating Home Dialysis Training Requirements: A Survey of Nephrology Program Directors and Division Chiefs

Nephrology Program Director Protected Time for Program Administration: A National Survey

Nephrology Program Director Protected Time for Program Administration: A National Survey

National Survey: Point-of-Care Ultrasound Use Among Nephrology Program Directors, Fellows, and Graduates

National Survey: Point-of-Care Ultrasound Use Among Nephrology Program Directors, Fellows, and Graduates

Nephrology Program Director Protected Time for Program Administration in the United States.

The Accreditation Council for Graduate Medical Education (ACGME) required that program directors receive 10-20 h/wk of protected time for program administration (including didactic teaching). In July 2022, this was reduced for all internal medicine subspecialties on the basis of program size, with 8 h/wk required for programs with fewer than seven fellows, the majority of nephrology programs. We surveyed all 151 US adult nephrology program directors (ACGME Public List of Programs 2021-2022) to determine how much protected time they receive, how much they think is necessary, and the division of their professional time. The anonymous 20-question online survey was administered from March 31 to April 30, 2022. The analysis was descriptive. Response rate was 66% (99 of 151). Geographic distribution and approved fellow positions were similar to programs nationally; 59% had fewer than seven approved positions. Median protected time was 10 h/wk (interquartile range, 5-10), with 8 h/wk (interquartile range, 5-10) for those with fewer than seven positions. Program directors estimated needing 12 h/wk (interquartile range, 10-16) to effectively administer programs, including those with fewer than seven positions, a median 5 h/wk (interquartile range, 0-7) more than received. Of program directors reporting <10 h/wk for program administration, 62% provided >20 hours of direct patient care. Thirty-nine percent had no protected time for core faculty. Fellow recruitment (68%) was the most time-consuming task, and didactic teaching (80%) was the most professionally rewarding. Approximately half of the nephrology programs surveyed were not in compliance with the ACGME-stipulated 10-h/wk minimum protected time for the 2021-2022 training year. Program directors estimated a median of 12 h/wk are needed to effectively manage programs.