Dialysis Fellowship - Curriculum

Objectives

  • To provide advanced training in dialysis techniques.
  • To encourage improvement in the care of end stage kidney failure patients.
  • To encourage innovation in the care of end stage kidney failure patients.
  • To provide practical experience in the interpretation and implementation of the regulatory issues and roles and obligations of a medical director of a dialysis unit.
  • To provide opportunities for research and quality improvement in the field of dialysis.
  • To provide teaching methods necessary to improve essential educational skills.
  • To provide the professional training necessary to excel as a clinician educator in an academic position or administrative position.
  • The program is expected to raise the level of technical expertise in the field of dialysis, along with generating innovative research advances in the field. It is our hope that fellows will disseminate novel approaches to the care of dialysis patients, and become leaders in academic, clinical and administrative fields.

Curriculum Details

    A variety of topics will be covered during the course of the dialysis fellowship and are intended to add educational content above and beyond what is routinely covered during a general nephrology fellowship. The dialysis fellow is expected to gain competence in all areas and be able to teach what he/she has learned to others by the end of the fellowship.

Active Training

  • Caring for a panel of chronic dialysis patients with an emphasis on exposure to home hemodialysis patients and peritoneal dialysis patients
  • Hands on experience performing all dialysis techniques including standard intermittent hemodialysis, pure ultrafiltration, hemofiltration, hemodiafiltration, SLED, SCUF and all forms of home dialysis techniques and technologies
  • Attending all relevant patient care (plan of care) and dialysis unit meetings.
  • Opportunity to spend extra time with interventional nephrologists, interventional radiologists, vascular surgeons and general surgeons to learn more about dialysis access procedures.
  • Coverage of the inpatient nephrology service limited to weekend call divided among all nephrology fellows.

Meetings/Committees

  • Northwest Kidney Center Medical Staff meetings
  • Northwest Kidney Center Medical Staff Executive Committee meetings
  • Northwest Kidney Center Medical Directors meetings
  • Northwest Kidney Center Technical / Water meeting
  • Scribner Kidney Center QAPI meetings
  • Scribner Kidney Center Staff In-service meetings
  • Harborview Vascular Access Committee
  • KRI Research Meeting
  • KRI Scientific Advisory Committee
  • KRI Patient Advisory Committee
  • Center for Dialysis Innovation Research Meeting

Research Projects

    Every fellow is expected to complete one clinical research or QAPI project and one technical or innovative project during the course of the fellowship. Fellows will have the opportunity to collaborate with researchers from the Kidney Research Institute (KRI) and the Center for Dialysis Innovation to initiate projects of interest or select ongoing projects to move forward. The following list provides examples of previous fellow projects.

    Technical Innovations

  • Development of advanced water purification techniques, water efficient dialysis techniques
  • Development of devices for the assessment of volume status in dialysis patients
  • Development of modeling programs and software for protocol driven in-center care (Epo protocol, vitamin D protocol)
  • Development of novel dialysate solutions
  • Home dialysis monitoring, home portals and electronic communication
  • Liver dialysis: albumin based liver dialysis
  • On-line hemodiafiltration used in out-patient setting
  • Sorbent dialysis
  • Use of extra-corporeal therapy in gene therapy for muscular dystrophy
  • Clinical Research/QAPI Projects

  • Association between pre dialysis serum bicarbonate level and dialysate acetate level
  • Development of new protocols for in center administration of Epo, Iron and Vitamin D
  • Dialyzer related thrombocytopenia
  • Enhancing patient education and understanding of dialysis lab monitoring
  • Inter-operative dialysis and citrate anticoagulation in liver failure,/
  • Outcomes of acute kidney injury requiring outpatient dialysis
  • Patient and technique survival among home dialysis modalities
  • Peritoneal dialysis catheter outcomes
  • Serum magnesium level and outcome in dialysis patients
  • Tracking quality metrics related to access placement