Interventional Nephrology

Interventional nephrology has become a growing and distinct discipline within nephrology. The first two articles in this special section deal with everyday issues that practicing nephrologists, dialysis nurses, and technicians encounter.

In “The PICC Conundrum: Vein Preservation and Venous Access,” Dr. Pflederer provides background on the increasing use of PICC lines and how their use impacts CKD patients who will require vascular access. Indeed, Dr. Pflederer’s article may serve as a resource for developing a PICC line use policy.

Dr. Besarab outlines the enormous impact that the all too frequent use of central venous dialysis catheters has on the morbidity and mortality of patients. He describes the three scourges of dialysis central venous catheters: maintaining patency, catheter-related infection, and central vein stenosis. The frequent use of central venous dialysis catheters has led to what many describe as an epidemic of central venous stenosis. Unfortunately, there are no durable endovascular or surgical strategies once central vein stenosis develops, often leading to permanent vascular access loss.

Dr. Agarwal describes multiple factors favoring peritoneal dialysis. The alignment of benefits to patients (for example, better initial survival, which may be related to not using a central venous dialysis catheter) and now financial benefits derived from the changes in reimbursement may lead to an increase in peritoneal dialysis in the United States. Perhaps these changes will lead to a “PD First” approach as a corollary to “Fistula First.”

Next, Drs. Rahbari-Oskoui and O’Neill outline the utility of ultrasonography when used by nephrologists. Several medical specialties have incorporated ultrasonography as part of their practice. Rahbari-Oskoui and O’Neill successfully argue that nephrologists can improve patient care by doing so. In many ways, ultrasound is supplanting the stethoscope.

In the final two articles in this issue, Dr. Dwyer discusses the development of interventional nephrology and Dr. Roy-Chaudhury discusses research opportunities in interventional nephrology.

Interventional nephrology, born in the private practice sector, has now evolved and matured with the development of formal training programs in academic medical centers. ASN has recognized the importance of these developments by establishing the Interventional Nephrology Advisory Group (INAG), which informs the ASN Council and Board of Advisors about issues of importance to the society.

Most recently, INAG has developed a comprehensive curriculum for academic-based nephrology training programs. As described by Dr. Roy-Chaudhury, INAG has also worked with other societies to recommend to the National Institute of Diabetes and Digestive and Kidney Diseases research initiatives germane to improving the care of kidney patients. This focus on research in dialysis vascular access should lead to improved patient care.

I hope that this special edition of Kidney News stimulates you, the reader, to learn more about interventional nephrology.

Notes

[1] —Jack Work, MD, chair of the ASN Interventional Nephrology Advisory Group, edited this special section for ASN Kidney News, along with KN editorial board member Edgar Lerma.


February 2012 (Vol. 4, Number 2)