Endovascular procedures performed by interventional nephrologists in Korea: Time to intervene

Over the last 20 years, interventional nephrology (IN) has become a new and emerging subspecialty of nephrology. The International Society of Nephrology has created an Interventional Nephrology Committee to improve the overall quality of patient care by promoting IN [1]. This has led to many young nephrologists taking the initiative and performing percutaneous endovascular procedures by themselves to avoid unnecessary delays rather than consulting with a variety of specialists. Financial data from the US Renal Data System suggest that surgeons, radiologists, and nephrologists are responsible for approximately 35%, 30%, and 25%, respectively, of vascular access costs, with the balance being split between anesthesiology and other specialties [2]. Since the establishment of the Korean Study Group for Interventional Nephrology in 2010 which was endorsed by the Korean Society of Nephrology in 2013, some frontier nephrologists interested in IN have performed these endovascular procedures in Korea. The study by Lee and Park [3] reported for the first time the effectiveness and safety of vascular access procedures performed by interventional nephrologists in Korea. The authors showed that the clinical success rate, primary patency rate, and secondary patency rate at 3 months were 89.3%, 56.6%, and 85.7%, respectively. Notably, these results exceeded the recommendations of the Kidney Disease Outcomes Quality Initiative guidelines: a clinical success rate 485% and a primary patency rate at 3 months 440%. However, the success rate of the current study was not conclusive as it did not establish the effectiveness and/or superiority of endovascular interventions by nephrologists according to a large series, showing a clinical success rate 495% by nephrologists in the US as well as by radiologists in Korea [4,5]. The authors also showed that the complication rate was 6.6%, being less than that of another report by interventional radiologists in one of the largest centers in Korea [3,5]. A comparison, however, could be made as complications were both listed (local infection, arterial wall injury, dissection, thromboemboli, fistulas, hematoma, acute occlusion, perforation, vasospasm, renal failure, stroke, myocardial infarct, etc.) and graded [6]. The authors did not describe complications according to the reporting standards of the Society of Interventional Radiology (SIR), although the authors mentioned