Abstract: SA-PO914

Nephrology Practice and Training in the Intensive Care Unit: Results of a United States Survey

Session Information

  • Educational Research
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Nephrology Education

  • 1301 Educational Research

Authors

  • Mccarthy, Paul J., University of Maryland, Baltimore, Maryland, United States
  • Huslin, kemsha Z., None, Smithsburg, Maryland, United States
  • Ali, Farhan, None, Smithsburg, Maryland, United States
Background

Renal pathology is common in the intensive care unit (ICU). Understanding of the entire ICU patient is optimal. We completed a survey looking at opinions of intensivists and nephrologists regarding renal replacement. There was agreement on many issues and disparity in some areas. We completed a second survey on ICU nephrology to identify potential areas for future study and imrpovements in our training program.

Methods

A survey on renal replacement was emailed to training program directors in critical care medicine and nephrology and to nephrologists from a department database. A second survey was emailed to program directors in nephrology and nephrologists from a department database with questions on practices and nephrology training related to the ICU. Questions in the second survey were the result of responses from the first survey.

Results

Respondents were from both academic and non-academic settings, large and small centers and were from all parts of the country. The 1st survey showed agreement among nephrologists and intensivists on indications to start renal replacement and dosing for CRRT. There were differences based on specialty in volume assessment and rounding patterns. Half of responding to the second survey stated that up to 50% of their patients are in the ICU. Most respondents report that they place dialysis catheters, manage hemodialysis, CRRT and half prescribe pheresis. 75% have not participated in a continuing medical education (CME) activity specific to ICU nephrology in the last year. Rarely respondents round on patients at night.
For training programs, less than half reported a minimal of proctored CRRT cases are required. 40% of training programs give renal fellows specific training in hemodynamic monitoring and 15% or less of programs report training fellows in ultrasound, mechanical ventilation or require a formal rotation as part of an ICU team.

Conclusion

Nephrologists spend a good portion of time seeing ICU patients. Most place dialysis catheters, manage hemodialysis, CRRT and many manage pheresis. 75% have not participated in a CME specific to ICU nephrology in the last year. Most nephrology training programs have no minimum requirement of proctored CRRT cases and most programs do not train fellows in hemodynamic monitoring, ultrasound, mechanical ventilation or require dedicated time as an ICU team member.