Advanced dialysis fellowship.

End-stage renal disease (ESRD) requiring dialysis or transplantation once thought to be an orphan disease now affects over 400,000 patients in the United States. Currently, renal transplantation offers the best option for renal replacement therapy. However, majority of patients with ESRD are treated by dialysis. Significant advancements have been made in dialysis technology since chronic dialysis became a viable option in 1960 when Dr. Belding Scribner successfully connected an artery and vein with Teflon tubing permitting repeated access to the circulation for the purpose of performing long-term hemodialysis. Over the past 50 years, the knowledge and understanding of the management of dialysis equipment and care of the dialysis patient has grown considerably. The potential for harm from improper management of dialysis patients in addition to the unawareness of complex reimbursement policies and regulatory oversight rules is ever present. The landscape of regulation and repayment for the services provided continue to be dynamic with strong focus on quality and outcome measures. Modifications are made yearly, and reimbursement for dialysis has become the first program to mandate penalties to dialysis providers for failure to meet quality benchmarks. As a nephrology trainee, it is often a daunting challenge to understand both the technical complexities of dialysis and the regulatory requirements that are incumbent on dialysis providers. The duration of a typical nephrology fellowship is 2 to 3 years depending on whether a trainee is pursuing a research or clinical career. Due to the growth in all fields of nephrology, epidemiology, and laboratory science, there is a wealth of knowledge the trainee must master in this short period of time. Given the complexities of both the technical and logistical aspects of dialysis, it is important to provide trainees with the option of advanced training in this critical area of nephrology. Besides focusing on clinical and academic training, trainees may often feel a desire to participate in innovation or to become a medical director of dialysis unit. However, there is a lack of established training programs to help fulfill such objectives. In general, there is a lack of thorough understanding of the engineering and technical components of a dialysis machine and related technologies as it is not mandated to be taught to nephrology trainees by the Accreditation Council for Graduate Medical Education (ACGME). The lack of exposure to the technical aspects of dialysis has led to a dearth of interest or focus on improving the existing technology. Early innovations in dialysis technology relied heavily on clinician guidance and collaboration with scientists, engineers, and technicians. Although dialysis technology has been refined over the years, not much progress has been made to bring additional technology and significant innovation to improve the morbidity and mortality of ESRD patients. The lack of structured mentorship and training has likely resulted in scarcity of clinician-driven innovation and research in the field of dialysis. Similarly, trained nephrologists also have only a minimum or no knowledge of regulatory issues associated with ESRD care. To address this gap in training, the University of Washington in collaboration with the Northwest Kidney Centers has created a 1-year advanced dialysis fellowship. The primary goals of the advanced dialysis fellowship are listed in Table 1. Recognition of the necessity of such a fellowship came from the Division of Nephrology at the University of Washington under the leadership of Professor Suhail Ahmad. Early work and collaboration with the Northwest Kidney Centers led to the support of nephrology fellows in the form of both education and funding. The Northwest Kidney Center is a small non-profit dialysis provider serving the majority of dialysis patients in the northwest Puget Sound region with a mission of promoting the Correspondence to: R. Munshi, MD, University of Washington, M/S OC.9.820 PO BOX 5371, Seattle, WA 98145-5005, USA. E-mail: [email protected] Hemodialysis International 2014; 18:S52–S54