Dialysis

I.     Program Content

1. Types, advantages, disadvantages, complications, and management of acute and chronic hemodialysis and peritoneal dialysis.

2. Available water treatment and dialysis delivery machines for hemodialysis and connection and cycling systems for peritoneal dialysis.

3. Currently available hemodialyzers, advantages and disadvantages with emphasis on difference in membrane composition, biocompatibility, and solute and water flux.

4. Importance of, and correct method of determining the dialysis prescription for hemodialysis and peritoneal dialysis, and of monitoring the actual delivered dose of dialysis.

5. The most common complications of hemodialysis including hypotension, cramps, arrhythmias, hemolysis, and air embolism.

6. The most common complications of peritoneal dialysis including peritonitis, hypotension, hernias, dialysate leaks, and inadequate dialysis.

7. Available techniques, advantages, and possible drawbacks of dialyzer reprocessing.

8. Continuous dialytic therapies including CAVH(/D), CVVH(/D).

9. Nutritional considerations and management of ESRD patients.

10. Evaluation and management of complications of ESRD including anemia, renal osteodystrophy, dialysis amyloidosis, hypertension, hyperlipidemia, acquired cystic disease.

11. Appropriate use of drugs, including dose modifications for dialysis patients.

12. Role of Medicare, HCFA, Networks, USRDS, and voluntary organizations/societies (e.g., NKF, ASN, RPA, AAKP) in the delivery and financing of care for ESRD patients.

II.    Patient Care Experience

1. Trainees must manage patients with acute renal failure requiring dialysis treatment including intermittent hemodialysis, continuous peritoneal dialysis, and the extracorporeal continuous renal replacement therapies.

2. Trainees must manage patients with chronic renal failure on maintenance hemodialysis longitudinally for a sufficient time to participate in the prescription of and monitoring of the dose of delivered dialysis, assessment and adjustment of the need for and dose of erythropoietin, evaluation and treatment of renal osteodystrophy, and ongoing evaluation of the dialysis access.

3. Trainees must manage patients with chronic renal failure on maintenance peritoneal dialysis longitudinally as outlined above for hemodialysis patients for suitability of various forms of dialytic therapy, along with a multi-disciplinary team.