Subspecialty fellows receive comprehensive training in all facets of inpatient nephrology. This occurs while on the three major rotations: Inpatient Consultation, Inpatient Chronic Dialysis/ESRD, and Transplantation.

First Year

• Inpatient Service - 9 months
• Outpatient transplant- 2 months
• Research - 1 month

Second Year

• Inpatient Service - 5 months
• Outpatient Transplant - 2 months
• Research - 5 months

Inpatient Service

The inpatient service consists of up to 6 Nephrology attendings, two or three fellows, internal medicine and/or residents in medicine-pediatrics, and medical students. Together, this group of physicians is responsible for the comprehensive management of all consults, chronic dialysis patients admitted to the hospital, and inpatient transplant patients. A range of four to eight new consults are requested each day. In addition, several newly admitted ESRD or transplant patients are seen daily. Approximately 50-70 established patients are followed daily.

The scope of the consults includes acute renal failure, acid-base and electrolyte disturbances, complications of chronic renal failure, and hypertensive emergencies and complications. Many of the daily consults are requested from the five ICUs, providing an opportunity to evaluate patients of all ages with a myriad of disease processes. The remainder of the consults are requested from general medical, surgical and obstetrical services.

Nephrology fellows are contacted with new consults to be distributed among the team. Urgent consults are evaluated immediately and discussed with the attending nephrologist. During these sessions, clinically-based discussions regarding disease process, pathophysiology, natural history, and management occur. Teaching rounds take place daily.

Fellows develop the skills necessary to manage complications, including access failure, acute infections, malnutrition, anemia, metabolic bone disease, and cardiovascular complications associated with ESRD.

Nephrology fellows learn to modify dialysis prescriptions in acutely-ill patients. There is an emphasis not only on managing complex medication regimens, but also on understanding the pharmacokinetics (clearance and metabolism) of commonly-used medications in hospitalized dialysis-dependent patients.

Fellows help lead a multidisciplinary team of students, nurses, dieticians, pharmacists, and discharge coordinators. They maintain correspondence with the primary nephrologist and outpatient dialysis unit throughout the hospital admission and upon discharge.

The fellow on this rotation performs transplant renal biopsies under ultrasound guidance and cares for all transplant patients admitted to Baystate Medical Center.

Transplant

Up to 50 new cadaveric and living donor transplants are performed each year. Nephrology fellows on the transplant service are part of a comprehensive team (transplant surgeon, staff transplant nephrologist, nurses, dietitians and social workers). All kidney transplant patients admitted to the hospital are managed primarily by the inpatient chronic dialysis/transplant team. Fellows are responsible for the medical management of new and chronic kidney transplant patients.

Nephrology fellows are exposed to the complex medical problems of the kidney transplant patient, and learn to modify immunosuppressant regimens in the setting of infection, acute illness, and other complications. Fellows learn to evaluate and manage acute rejection, using novel techniques such as plasmapheresis and state-of-the-art chemotherapeutic protocols.

During this rotation, fellows attend the daily outpatient transplantation clinic and weekly transplant conferences.

Research

The nephrology fellow is exposed to numerous options for clinical research. At Baystate Medical Center, there are more than 30 ongoing nephrology clinical trials. The purpose of the research rotation is to allow the nephrology fellow to understand the development of research ideas, the nuances of study design for a research project, to learn proper informed consent, to develop a consent form, to learn to develop a protocol, and to carry out clinical research in a kind, compassionate, and humanistic way.

The nephrology fellow has the opportunity to participate in clinical trials and/or independent investigator-initiated research studies. In addition, the fellow has the opportunity to be a peer-review journal reviewer for papers submitted to many nephrology journals in which the faculty serve either on the editorial board or as scientific reviewers. Fellows have the opportunity to present their research at national meetings including the NKF and ASN.

Outpatient Continuity Clinic

Fellows have one half day in the nephrology continuity clinic per week.

Outpatient Hemodialysis Rounds

Pioneer Valley Dialysis and Western Massachusetts Kidney Center are the flagship dialysis facilities for Western Massachusetts at which patients from Baystate Medical Center receive dialysis care. Patients requiring admission are admitted to Baystate Medical Center's renal inpatient transplant dialysis floor.

Each fellow is assigned and rounds on one dialysis shift every other week of hemodialysis patients at either Pioneer Valley Dialysis or Western Massachusetts Kidney Center, with an attending nephrologist also assigned who is responsible for the care of those patients. This allows fellows to have complete continuity in caring for patients on their dialysis shift.

In addition, fellows are responsible for a monthly home hemodialysis clinic during their second year, caring for patients on slow nocturnal hemodialysis, the next stage home hemo system, or on standard home hemodialysis.

Peritoneal Dialysis Clinic

A separate longitudinal continuity clinic of up to 10 peritoneal dialysis patients per session is held monthly. The fellow is the first nephrologist consulted by the peritoneal dialysis nursing staff. This allows the nephrology fellow to learn all aspects of the longitudinal care of peritoneal dialysis patients.