Understanding Interventional Nephrology: Key Insights and Benefits

Many patients who have had long-term diabetes, high blood pressure, or other risk factors that make them prone to kidney disease may require the help of a nephrologist. If the treatment requires a higher level of care than just medication management then they will need the subspecialty of interventional nephrology.

What is an interventional nephrologist? What kind of programs and training do they receive? Which procedures are they certified to perform?Let’s answer those questions together and examine the role of nephrology in kidney patient care.

What is an Interventional Nephrologist?

Interventional nephrology focuses on renal ultrasonography and catheter placement to treat people with kidney diseases and dialysis patients. This relatively new subspecialty was developed by physicians who wanted better quality care for their renal patients.

Physicians desiring to specialize in interventional nephrology must find an interventional nephrology fellowship program. This might be difficult as there are relatively few accredited programs in the United States. These programs are generally a year in length. The interventional nephrology fellowship program is typically available to nephrologists who have completed their residency in internal medicine.

These nephrology training programs allow nephrology fellows to work at academic centers alongside trained interventional nephrology doctors to learn about procedures for hemodialysis and peritoneal dialysis treatment, placement of hemodialysis catheters, and renal ultrasonography. Training programs aim to ensure clinicians have a comprehensive understanding of dialysis access care and complications.

The American Society of Diagnostic and Interventional Nephrology (ASDIN) Certifications

The American Society of Diagnostic and Interventional Nephrology certifies doctors who complete an interventional nephrology program and demonstrate proficiency in the procedure for which they seek certification. Fellows can achieve ASDIN certification upon completing a minimum number of procedures. The ASDIN offers certifications in the following areas:

• Hemodialysis vascular access (HVA)
• Peritoneal dialysis catheter (PD)
• Ultrasound
• Tunneled catheter only

Procedures Performed by Interventional Nephrologists

One role of an interventional nephrologist is to preserve kidney function for as long as possible in end-stage renal disease patients. Another is to diagnose and treat other kidney disease. They have received training in procedures that focus on the health of the kidneys.

Now that we have gone over what interventional nephrology is and the certifications interventional nephrology offers, let’s dig deeper into what each of these procedures in this nephrology subspecialty entails.

Hemodialysis Vascular Access

Hemodialysis vascular access allows a large amount of blood to flow during hemodialysis treatments. During this procedure, the doctor will place an arteriovenous fistula, graft, or another catheter. The preferred access for this type of dialysis is the arteriovenous fistula because it is less prone to clotting and will give longer dialysis access. There are risks of complications from arteriovenous fistulas and grafts, though. They are prone to stenosis and need frequent monitoring from the nephrologist.

Peritoneal Dialysis Catheters

A peritoneal dialysis catheter is a flexible tube placed into the abdomen to allow dialysis access. Peritoneal dialysis access gives the patient greater flexibility for end-stage renal disease (ESDR) care. After doctors place the catheter, dialysis patients can perform their dialysis at home. The peritoneoscopic technique for inserting PD catheters reduces the risk of complications.

Ultrasound

Ultrasound imaging directs high-frequency sound waves into the body and records the echoes that bounce back. This provides a physician with a visualization of the structure of organs and tissue.

Ultrasound is an invaluable tool for nephrologists in the diagnosis and treatment of kidney disease. This tool can be used to assess kidney dysfunction. It can be helpful in identifying optimal locations for fistulas or grafts. Interventional nephrologists also use ultrasound to guide them in performing renal biopsies.

Tunneled Dialysis Catheters

Tunneled dialysis catheters have two tubes, one that carries blood to the dialysis machine and one that carries blood from the machine back to the patient. An interventional nephrologist will place the catheters in a vein near the neck and then thread them closer to the heart.

This type of dialysis access is not an ideal permanent solution because the catheter cannot get wet. Doctors typically perform these procedures on patients whose anatomy requires a different type of dialysis access or on those who are not ESRD patients. They may also place this access as a temporary solution until they can perform a more permanent graft or catheter procedure.

An interventional nephrologist might perform this procedure on a patient with acute kidney disease.

The Important Role of Interventional Nephrology in Patient Care

As mentioned, interventional nephrology was developed because doctors saw a need for their kidney disease patients to receive better dialysis access care. These caring doctors noticed that the surgeries now done with interventional nephrology were being performed by other doctors and that resulted in issues that could have been prevented with personalized care and speedy treatment. Most of the procedures performed with interventional nephrology are done on an outpatient basis.

Hemodialysis and peritoneal dialysis are important treatments for ESRD patients. Interventional nephrology assures the nephrologist is actively involved in the timely completion of procedures necessary for dialysis access.

Conclusion

Interventional nephrology has become recognized worldwide as a standard of care in dialysis access management. It improves patient care by providing outpatient services and reducing hospital admissions. While programs and centers for specialized training for interventional nephrologists in the United States are few, they are invaluable in handling endovascular procedures for dialysis patients and other nephrology patients.