Point-of-Care Ultrasound Use in Nephrology: A Survey of Nephrology Program Directors, Fellows, and Fellowship Graduates

Home Hemodialysis Practice and Curriculum Recommendations Among Graduates of a Military Nephrology Training Program Without Home Hemodialysis Clinic Experience

INTRODUCTION

The Advancing American Kidney Health Initiative set a goal that ≥80% of new end-stage kidney disease patients receive home dialysis or kidney transplant by 2025. Home hemodialysis (HHD) prevalence remains low, and one barrier may be a lack of familiarity with HHD among nephrologists and insufficient training during fellowship.

MATERIALS AND METHODS

We performed an anonymous survey of 92/94 graduates from the Walter Reed military nephrology program (1984-2023) regarding their HHD practice and training. The home dialysis program includes only peritoneal dialysis, and HHD training is limited to didactics and training with machines used for low-flow dialysate HHD. The survey was conducted from April 12, 2023 to April 2, 2024.

RESULTS

Fifty-two out of ninety-two (57%) responded; 96% completed the survey. Seventy-five percent (38/51) had been in practice for ≤20 years. Forty-three percent (22/51) practice(d) HHD. Of these, 54% (12/22) had been HHD directors/co-directors, and 73% (16/22) had started practice in the last 10 years. The majority were in the southern (50%) or western (23%) United States, and 32% had rural practices. 54% (12/22) followed 6 to 10 patients. Sixty-eight percent reported learning HHD skills "on the job." Barriers most commonly cited were lack of patient interest (41%), lack of patient partners (27%), and lack of nursing staff (27%). Overall, graduates indicated that the minimum effective curriculum for HHD competence should include block/longitudinal HHD clinic (84%), familiarization with HHD machines (82%), didactic lectures (80%), and training in effective counseling (80%).

CONCLUSIONS

Among graduates of a military nephrology training program without HHD clinic experience, 43% reported subsequently practicing HHD, the majority learning "on the job." Overall, graduates indicated that block/longitudinal HHD clinic was the most effective way for fellows to learn HHD skills. Nephrology programs should expect that graduates are likely to care for HHD patients, and prepare them accordingly. In addition, for military nephrologists, HHD skills can be applied to dialysis delivery in austere settings.

Point-of-care ultrasound training in nephrology: a position statement by the International Alliance for POCUS in Nephrology

Point-of-care ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and 'lack of' standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond.

Effectiveness of a Brief Point of Care Ultrasound Course at a National Nephrology Conference

The rising demand for point of care ultrasound (POCUS) instruction during nephrology fellowship has been limited due to a shortage of trained faculty and courses designed specifically for nephrologists. A hands-on POCUS pre-course was organized during the April 2023 National Kidney Foundation (NKF) Spring Clinical Meeting to address this challenge. The course consisted of pre-recorded lectures and a 4-hour hands-on workshop guided by multidisciplinary POCUS experts. The anonymous post-course survey received responses from 25 out of 39 participants, yielding a 64.1% response rate. On a scale of 0-10, confidence levels for acquiring kidney images rose from 2.6 + 2.3 (mean + SD) pre-workshop to 7.8 + 1.5 post-workshop (p<0.001). Similarly, a remarkable improvement in confidence for acquiring lung and cardiac images was seen as scores increased from 1.8 + 2.4 to 7.7 + 1.5 (p<0.001) and from 1.5 + 2.2 to 7.2 + 1.3 (p<0.001), respectively. Additionally, respondents reported a substantial improvement in their confidence to interpret kidney, lung, and cardiac POCUS images, with scores increasing from 4.5 + 2.2 to 7.7 + 1.1 (p<0.001), 2.3 + 2.4 to 7.6 + 1.5 (p<0.001), and 2 + 2 to 7.3 + 1.5 (p<0.001), respectively. Barriers to implementing POCUS use at institutions included a perceived lack of trained faculty, limited protected time for faculty, and insufficient support from division leadership. The NKF POCUS pre-course successfully improved participants' confidence in acquiring and interpreting basic POCUS images.