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Training and Curriculum

The clinical training program is divided among five services:

1. University Consult Service at KUMC: five months a year

The Nephrology Consult Service performs most of the adult nephrology consultations in KU Hospital. The service is divided into A, B and C services staffed by three faculty. The service is weighted toward acute kidney injury, and fluid and electrolyte disorders in patients in the medical and surgical intensive care units.

Fellows learn to manage a broad spectrum of kidney disorders in critically ill patients with cardiac disease, liver failure, post-solid organ and bone marrow transplant and multi-organ failure. They have ample opportunity to get hands-on experience at acute hemodialysis, continuous venovenous hemodiafiltration, hemodialysis catheter placement and kidney biopsies.

2. Inpatient Transplant Consult Service: two months a year

The Inpatient Service at KU hospital takes primary responsibility for the care of patients receiving kidney transplants as well as transplant recipients readmitted for medical complications. We perform more than 120 kidney transplants per year.

Fellows learn acute management of post-op transplant patients, dosing of immunosuppressive medications, and the diagnosis and management of acute and chronic rejection, opportunistic infections, and other complications. They learn to interface closely with the transplant surgical team and with various consult services, including infectious diseases.

3. Outpatient Transplant Clinic Service: two months a year

On the Outpatient Transplant Service at KU, nephrology fellows learn pre-transplant donor and recipient evaluation and post-transplant care of patients with kidney, simultaneous pancreas-kidney, pancreas only, and simultaneous liver-kidney transplant patients in the clinic setting. They also participate in regular multidisciplinary meetings in which individual patients are presented and discussed in detail.

4. Outpatient Dialysis Service: two months a year

On the Outpatient Dialysis Service, fellows round daily in the University's 40-station outpatient dialysis unit located nearby the hospital.

The emphasis of the rotation is on learning to evaluate and manage patients undergoing in-center hemodialysis including managing dialysis prescriptions, hematologic and bone mineral parameters, and handling infectious and vascular access complications. Fellows attend a weekly home dialysis clinic where we follow 24 patients who receive home hemodialysis and continuous ambulatory or cycling peritoneal dialysis.

Fellows receive education in water treatment, dialysis machine operation, and are trained in cannulating hemodialysis accesses and performing peritoneal exchanges. They actively participate in multidisciplinary patient evaluations, and in the quality improvement activities of the dialysis unit.

5. Elective Rotation: one month a year

Fellows can customize this rotation to fit their interest. Options include: 

Research: You may design your own project and focus on an area of interest. You will select a research mentor from the program faculty who will help guide you on the project of your choice.
Interventional Nephrology: This rotation involves experience in an outpatient access center that exclusive preforms procedures on dialysis patients by an interventional nephrologist. 
Renal pathology: This rotation is spent with a pathologist who specializes in renal pathology reading several kidney biopsies that are performed over the month
Plasmapheresis: KUMC has a strong plasmapheresis program that is managed by pathology. This rotation allows for fellows get comfortable prescribing plasmapheresis.
Dialysis: Fellows can choose to spend more time in outpatient dialysis unit, focusing on either home or incenter.
Transplant: Fellows can choose to spend more time working with transplant team working with the Midwest Transplant Network or working with the clinical transplant team.


Outpatient Experience

 

1. Continuity Nephrology Clinic

The continuity clinics for nephrology fellows at KU Medical Center have been designed so that each fellow has their own clinic and patient panel with rotating attending preceptors. The clinic is 1 half day per week for the entirety of their fellowship training. In this way, the fellow can follow the same group of patients throughout. Clinical skills are developed through feedback from the attending physician.

The clinics are structured such that the fellow sees a wide variety of patients including those with acute and chronic kidney diseases, refractory hypertension, proteinuria, hematuria, electrolyte abnormalities, acid-base disturbances, cystic diseases, nephrolithiasis, and renal abnormalities associated with other medical illnesses such as end-stage liver disease, lupus and multiple myeloma. Due to the chronicity of many diseases seen in these clinics, most patients will be seen in follow-up several times per year by the same fellow.

2. Continuity Incenter Hemodialysis Clinic

All fellows are assigned a small panel of dialysis patients at the start fellowship. They round on theses patients once a month for the duration of their fellowship with the attending staffing the dialysis unit that month. This provides a longitude experience for the fellows in managing chronic dialysis patients on top of the intensive 1-month rotation in the unit.

3. Home Dialysis Clinic

Overall, the department has 3 faculty that specialize in home dialysis with around 60 home patients. This includes peritoneal dialysis, home hemodialysis, and nocturnal dialysis. Fellows are expected to attend all home clinics when on dialysis rotations and elective rotations.

4. Specialty Nephrology Clinics

Our department has 4 specialty clinics a glomerulonephritis clinic, PKD clinics, and Stone Clinic. Fellows can elect to attend any of these clinics during their elective rotations.

Night Call

All fellows take overnight call from home from 5pm -7am. A fellow can expect to have 5 night calls a month; this does not change based on number of fellows the program takes.


Fellow Rotation Schedule


 JULY  AUG  SEPT  OCT  NOV  DEC  JAN  FEB  MAR  APR  MAY  JUN
 Fellow A  Cx A  Dialysis  Cx C  Tx Consult  Elect/Res  Tx Clinic  Cx B  Dialysis  Cx A  Tx Consult  Tx Clinic  CxB
 Fellow B  Tx Clinic  Tx Consult  Cx A  Dialysis  Cx B  Tx Consult  Cx C  Tx Clinic  Dialysis  Cx B  Elect/Res  CxA
 Fellow C  Dialysis  Cx A  Tx Clinic  Cx B  Tx Consult  Cx A  Elect/Res  Cx B  Tx Clinic  Dialysis  CxC  TxConsult

Last modified: Aug 24, 2020
Schedule

Each service has a fellow and sometimes a resident and/or medical student who is responsible for coverage from 8 a.m.-5 p.m. on weekdays and 8 a.m.-noon on Saturdays.

After hours, coverage is provided by the on-call fellow who is responsible for all emergency consultations and handling any questions regarding the patients that the Nephrology service has been following.

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