Kristin Hoover, Amanda Dijanic Zeidman, and Javier A. Neyra
What is nephrology critical care?
The census of hospitalized critically ill patients has risen over the last decades (1). As this population expands, leaders of intensive care units (ICUs) are attempting to diversify the healthcare team. A rapidly expanding area within the diversified ICU team is nephrology critical care. The combination of nephrology and critical care is a seamless amalgamation of physiology, pathobiology, and organ crosstalk, which renders the clinician equipped with expertise in acute kidney injury, acid-base/electrolyte disorders, and volume management (Figure 1).
Importantly, as the critically ill population becomes sicker, reliance on
Kidney transplantation is the optimal treatment for kidney failure (1). As recently as 2019, there were 244,000 kidney transplant recipients (2) with a functioning kidney allograft, and this number continues to grow (3, 4). Thus, it is very important that we strive to ensure our workforce is trained to be able to care for this group of patients. A 2020 review article (5) estimates there are 1200-1400 transplant nephrologists in the United States. There are 149 accredited nephrology training programs in the United States (6) and <50% (63/149)
Nidhi Aggarwal, Harshitha Kota, Natasha N. Dave, and Ankur Shah
Most nephrologists consider peritoneal dialysis (PD) to be the best therapy for planned initiation of dialysis and frequent home-based hemodialysis (HD) as the best long-term therapy not only for patients with end stage kidney disease (ESKD) but also for themselves (1). A major barrier to increasing home dialysis therapies is the limited training in most US nephrology fellowship programs. Based on multiple national surveys, graduating trainees do not feel well trained and competent in either form of home dialysis (2, 3). Another survey of nephrology fellowship program directors identified lack of sufficient patients on
Patients with advanced kidney disease are increasingly older with multiple comorbidities and cognitive and functional impairments and have a limited life expectancy (1). They experience high symptom burden and recurrent hospitalizations and undergo aggressive medical interventions at the end of life with high inpatient mortality and low utilization of hospice services (2). Palliative care, which focuses on the optimization of quality of life, can be delivered alongside chronic kidney disease care. Primary palliative care skills that all nephrology providers should use (2–4) include the following:
The past year has been an arduous one. Amid the pandemic, we swiftly evolved in delivering our primary mission: patient care and education. The need for physical distancing did not culminate into any separation of trainees from education, with the majority of trainees agreeing that the educational endeavors of their programs were unaffected as a result of the pandemic (1). Local institutions and national organizations, led by prominent educators, continued to conduct conferences via innovative virtual platforms with high-quality content reaching audiences all over the globe. This edition of Kidney News is dedicated to trainees and
Edward Kwakyi, Sayna Norouzi, Kate J. Robson, and Harish Seethapathy
I am a newly qualified nephrologist, currently working in the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. At KBTH, where we run a weekly glomerular diseases clinic, my experience has been rewarding but not without challenges; these include a prolonged turnaround time for kidney biopsy results and choosing reasonable alternatives when standard-of-care medications are not affordable or available.
My experience as a GlomCon fellow has been immeasurable. The opportunity to learn and interact with pacesetters in glomerular diseases has been an invaluable experience. The histopathology sessions with phenomenal nephropathologists have demystified a vital tool that I had previously approached
David Massicotte-Azarniouch, Stephanie S. Pavlovich, and Koyal Jain
Medical knowledge and patient complexity are rapidly growing, particularly in nephrology, one of the most complex medical sub-specialties (1). This complexity allows for diversity in practice as nephrologists often develop niche areas of expertise including glomerular diseases, home dialysis, and transplantation, among others. Glomerular diseases are a particularly stimulating aspect of nephrology. The multi-systemic nature of these diseases tends to elicit interest from individuals with a strong intellectual curiosity. The ability to effectively treat glomerular diseases, in some cases warding off kidney failure, can make it an extremely rewarding process. In addition, the chronic nature of these diseases
Isabelle Dominique Tomacruz, Corina Teodosiu, Sophia L. Ambruso, and Michelle Lim
The rise of social media (SoMe) and free open-access medical education (#FOAMed)
The internet and social media have revolutionized the way medical information is disseminated, presented, and consumed. There is a rapid uptake of virtual and mobile-optimized modalities, where FOAMed tools are becoming a preferred modality for medical education (1–5). FOAMed differs from traditional medical education in that teaching and learning occur asynchronously within the virtual space, outside of traditional institutions and a lecture-based format. Although virtual education has grown exponentially over the last several decades, gaining the skills to harness social media as an educational
Elinor C. Mannon, Matthew A. Sparks, and Samira S. Farouk
Mentorship and early educational experiences play critical roles in influencing trainees' long-term career goals, and the field of nephrology is no exception. Like any specialty, one's decision to pursue nephrology likely results from a combination of clinical experiences, nephrology education, and mentorship both during medical school and residency. A majority of nephrology fellows previously reported deciding to pursue a nephrology fellowship during residency (1), and 33% of US internal medicine subspecialty fellows who did not choose nephrology identified the lack of a clear mentor as being one of the reasons for not doing so (2). Additionally,
Popularized by cutting-edge research, on the wards, and even on social media, point-of-care ultrasound, or “POCUS,” has the potential to change the way we practice medicine. Widely implemented in numerous clinical settings, current ultrasound devices are made to be compact and affordable, and an argument could be made that POCUS should be incorporated into the routine physical exam. Although many specialties of medicine have adopted this tool for everyday practice, it remains absent, underused, or undertaught in many nephrology training programs and practices. In addition, per the 2017 ASN workforce fellow data, 44% of respondents felt their programs lacked ultrasound