Year One

The largest Dialysis Unit in our Program is the Adam Linton Dialysis Unit at Victoria Hospital, where 175 patients receive hemodialysis treatment. This is where the trainees are located for their Hemodialysis Rotation. The trainees are expected to function as a Junior Consultant assisting the Nurse Practitioners in the care of the dialysis patients.  The trainee attends multidisciplinary review meetings for the hemodialysis patients twice a week, where they get exposure to urea kinetic modeling, dialysis prescription, transonics for evaluation of vascular access, anemia management etc. The trainee is responsible for temporary dialysis catheter placements, when necessary, for the hemodialysis patients, and also has the opportunity to learn how to place tunneled dialysis catheters. This rotation teaches the trainee about importance of the team approach in the care of patients on hemodialysis. The trainee meets with the Nephrology Consultant once a week for didactic teaching around important hemodialysis topics. It is mandatory that the following 8 topics be covered during the two-month Hemodialysis Block. These teaching sessions are in addition to the Academic Half Day.

1. Urea Kinetic Modeling in Hemodialysis: principles and clinical application
2. Vascular Access for Hemodialysis: temporary access and permanent access (AV fistual, AV Graft, Perm-Cath)
   - Advantages and disadvantages of each
   - When to place
   - How to monitor patency
   - Management of access stenosis/thrombosis/recirculation
3. Management of Hypotension/Hypertension in the hemodialysis patient
4. Management of Anemia in the hemodialysis patient
5. Management of Calcium/Phosphate/PTH Disorders in the hemodialysis patient
6. Appropriate management of line sepsis - exploring controversies
7. Dialyzer Reactions - presentation and management
8. Water Treatment in the Dialysis Unit

The Home Dialysis Rotation is situated at the Kidney Care Center (KCC). During this rotation, the trainees are expected to learn about all forms of home dialysis therapies, including peritoneal dialysis, conventional home hemodialysis and home quotidian hemodialysis. We currently have approximately 150 patients on peritoneal dialysis and 50 patients on home hemodialysis under our care. During this rotation the trainees attend peritoneal dialysis and home hemodialysis clinics and meetings. They also have the opportunity to learn how to percutaneously place peritoneal dialysis catheters. 

Our kidney transplant training program is accredited by both the American Society of Transplantation (AST) and the Royal College of Physicians and Surgeons of Canada (RCPSC) as an Area of Focused Competence (AFC). This is a combined in-patient/out-patient rotation at University Hospital. The trainees work under the supervision of the Transplant Team, which includes Transplant Nephrologists and Transplant Surgeons. Over the last few years, approximately 120-150 kidney transplants have been performed each year; this includes deceased donor, living-related and living un-related transplants. The trainees are expected to look after the transplant patients in the pre and peri operative period, and during their hospital stay. They are also expected to attend four transplant follow-up clinics, a transplant donor assessment clinic and a transplant recipient assessment clinic each week. The trainees also attend a monthly Renal Transplantation Journal Club and all combined medical and surgical transplant rounds to review program policies and complex patients on the waiting list. The trainee has the opportunity to perform kidney transplant biopsies under appropriate supervision.

The trainees are expected to attend General Nephrology ambulatory clinics under the supervision of the Nephrology Consultant. A clinic schedule is prepared for them prior to beginning their rotation. These clinics include both General Nephrology and Progressive Renal Insufficiency Clinics. The trainee is expected to dictate clear and concise clinic notes on the patients they assess. The trainee is also expected to follow up on laboratory investigations and imaging tests, and, if necessary, communicate the results to the referring physician or to the patient. During this rotation, the trainees are also expected to attend satellite hemodialysis clinics with one of the Consultants. We currently care for approximately 350 patients undergoing in-centre hemodialysis treatment through our 8 satellite units. 

Victoria Hospital has a large Oncology and Internal Medicine service, as well as the Regional Trauma Centre. Therefore, it provides a busy consultation service with a high incidence of acute kidney injury. Under the supervision of the Consultant on-call, the trainees are responsible for the management of all forms of renal replacement therapy in the ICU and on the wards, including continuous renal replacement therapy (CRRT), conventional hemodialysis, peritoneal dialysis and plasmapheresis. The trainee is also responsible for performing native kidney biopsies and all temporary hemodialysis catheter placements. Victoria Hospital also has an in-patient Nephrology Service that is staffed by Internal Medicine Residents. The Nephrology trainee is available as a resource for them when it comes to managing acutely ill patients and establishing dialysis access. 

University Hospital has a very large Multi-organ Transplant Program and Cardiovascular Surgery Division. The flavour of patients seen at University Hospital is therefore, vastly different from that of Victoria Hospital. The trainee is responsible for managing a busy consultative service at this hospital, with supervision from the attending Nephrologist. The trainee also supervises junior Internal Medicine Residents who are rotating on the Consult Service. This gives the trainee opportunities to develop and advance their leadership skills. The trainee leads meetings twice a week with Allied Health Staff to review current patient issues. The trainee is also responsible for all Nephrology consultations in the Medical and Surgical ICU and manages all forms of renal replacement therapy including continuous renal replacement therapy (CRRT), conventional hemodialysis, peritoneal dialysis and plasmapheresis. The trainee is also responsible for all temporary dialysis catheter placements and native kidney biopsies under appropriate supervision.