Recognized by the International Society of Hemodialysis (ISHD), we offer a formal Advanced Nephrology Dialysis Fellowship (academic/research track)

The Dialysis Fellowship training program prepares leaders in academic, clinical and administrative fields.

We offer a unique opportunity to train those who have already completed education in an accredited nephrology fellowship training program as dialysis experts. The year-long advanced clinical research fellowship track allows trainees to conduct research in the dialysis field and gain advanced training in dialysis techniques.

Goals

Trainees will have access to a multidisciplinary team of experts in the field of dialysis to learn from. Recognizing the importance of increased involvement of the nephrologist in the dialytic care of the patients, the Center for Medical Services (CMS) has emphasized the central role of the medical director in the dialysis facility. The Medical Director is responsible for the quality of care of all patients, the quality of technical services such as water treatment in the facility and the continued education of dialysis unit staff. Thus, there is a need for advanced training in the field of dialysis to improve quality of care and to train nephrologists in the regulatory aspects central to the provision of dialysis care so that they can fulfill the role of the medical directors of dialysis facilities.

Chuck Lee Wearable artificial kidney patient trial
Chuck Lee, one of the patients in the early clinical testing of the Wearable Artificial Kidney, sports the experimental device while standing next to a standard kidney dialysis machine.

The dialysis fellowship seeks to develop a cohort of clinician researchers who are interested in developing new and innovative technology in the field of dialysis.

The program is expected to raise the level of technical expertise in the field of dialysis and generate 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.

Advanced Dialysis FellowshipHemodialysis International 2014; 18:S52-S54

Eligibility

This 12 month fellowship is offered to those who have completed a formal ACGME Nephrology Fellowship Training Program, and who are Nephrology board eligible.

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.

Curriculum Details

A variety of topics (pdf) 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 and 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