Nephrology Fellowship
We are proud to offer an ACGME accredited 2 year Nephrology Fellowship Program at Baystate Medical Center/Tufts University School of Medicine. We currently offer 2 positions per year. Our program emphasizes 18 months of exceptional clinical training and includes a consecutive 6 month research block in the second year.
Baystate Medical Center serves a population of patients from Southern Vermont and New Hampshire, Eastern New York and Northern Connecticut and Western Massachusetts which includes a population of approximately one million patients. In addition, we have committed resources to a state-of-the-art eight station inpatient acute hemodialysis unit which is on the same floor as the inpatient renal and transplant floor. Patients who have dialysis needs and transplant needs have priority admission to this floor which allows geographic ease for the care of the patients in a medical education of internal medicine residents and nephrology fellows.
Our faculty performs approximately 200 native kidney biopsies and over 150 transplant renal biopsies each year. Nephrology fellows will have ample opportunity to perform both native and transplant kidney biopsies. The expected number of native renal biopsies per fellow would be at least 20 and for transplant kidney biopsies at least 15 by the completion of the nephrology fellowship.
Temporary vascular access lines for hemodialysis are placed daily at Baystate Medical Center. Placement of temporary vascular access lines in the internal jugular vein and/or femoral vein will be learned both with and without ultrasound guidance.
The ambulatory experience for fellows consists of participation in three major areas; continuity clinic, outpatient dialysis and transplantation clinic. Outpatient dialysis and continuity clinics will be maintained throughout the first two years. Transplantation clinic will be attended during the transplantation rotations.
ROTATIONS:
Subspecialty fellows will receive comprehensive training in all facets of inpatient nephrology. This will occur while on the three major inpatient rotations; Inpatient Consultation, Transplantation, and Chronic Dialysis/ESRD.
Consult Service:
The consult team consists of two attending nephrologists, one fellow, and 1-3 internal medicine residents.
An average of 2-5 new consults are requested each day. Approximately 20-30 established patients are followed. The scope of the consults ranges from 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 will be contacted with new consults to be distributed among the team. Urgent consults will be evaluated immediately and discussed with the attending nephrologist. Non-urgent consults will be discussed with the consultation team on afternoon rounds. During these sessions, clinically-based discussions regarding disease process, pathophysiology, natural history, and management will occur. Teaching rounds will take place daily.
During these rounds nephrology fellows will be responsible for the oversight and supervision of medical residents on the team, as well as, making decisions regarding initiating renal replacement therapy. In addition, fellows will be instructed in the placement of femoral and internal jugular hemodialysis catheters.
Chronic Dialysis/ESRD:
Nephrology fellows will be responsible for the comprehensive management of any ESRD patients on hemodialysis or peritoneal dialysis admitted to the hospital. Fellows will 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 will learn to modify dialysis prescriptions in acutely ill patients. There will be 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 will help lead a multidisciplinary team of students, nurses, dietitians, pharmacists, and discharge coordinators. He/she will maintain correspondence with the primary nephrologist and outpatient dialysis unit throughout the hospital admission and upon discharge.
Transplant Service:
More than 60 new cadaveric and living donor transplants are performed each year. Nephrology fellows on the transplant service will be part of a comprehensive team (transplant surgeon, staff transplant nephrologist, nurses, dietitians and social workers). All kidney transplant patients admitted to the hospital will be managed primarily or in consultation by the transplant service. Fellows will be responsible for the medical management of new and chronic kidney transplant patients.
Nephrology fellows will be exposed to the complex medical problems of the kidney transplant patient, and learn to modify immunosuppressant regimes in the setting of infection, acute illness, and other complications. Fellows will learn to evaluate and manage acute rejection, using novel techniques such as plasmapheresis and state of the art chemotherapeutic protocols.
During this rotation fellows will attend the daily outpatient transplantation clinic and weekly transplant conferences. In addition, transplant kidney biopsies (acute and protocol) will be performed by the transplant nephrology fellow.
RESEARCH:
Research has always been an important mission of the Nephrology Division at Baystate Medical Center. Currently there are over 20 on-going clinical trials studying different formulations for treating hyperparathyroidism in chronic dialysis patients, iron repletion therapy in dialysis patients and new formulations to treat the anemia of renal failure in both predialysis and dialysis patients
The Nephrology Division has won inclusion in several important clinical trials:
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The renal division has been invited to join the Dialysis Access Consortium to utilize two protocols to study medications to prevent dialysis fistula or access graft clotting. These studies will run through 2007.
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The NIH CORAL Trial: This is a study randomizing patients with renal artery stenosis to medical therapy or angioplasty with stent. This is a multicenter trial in the
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Nephros RAD Study: This is a trial of the new renal assist device RAD to improve mortality in patients in the intensive care unit with acute renal failure who undergo CVVAH.
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Sharp Trial: This is a study utilizing the new drug Vytorin in both pre ESRD and end-stage renal disease patients to see if better cholesterol control can improve mortality in these patient populations.
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Collaborative Study Group: The collaborative study group has a new trial with Keryx to study the drug suledoxide, a product with heparin qualities which can inhibit oxygen free radial formation to see whether this can slow progressive renal deterioration in chronic didactic nephrolopathy.
In addition to pharmaceutical funded research, Dr. Braden oversees a large research initiative of investigator initiated research. Studies currently underway include:
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The most in-depth study ever performed to study risk factors for sudden cardiac death in dialysis patients.
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A study of suicide and para suicide in chronic dialysis patients.
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The development of new EKG criteria to diagnosis hyperkalemia in dialysis patients.
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Continuous arterial venous hemodialysis during cardiac bypass surgery in patients with potassium rich cardioplegia.
The main research emphasis of the Renal Division at Baystate Medical Center is:
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Studies to slow progressive chronic renal failure
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Studies of new therapies for the complications of chronic renal failure and pre ESRD
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Renal tubular disorders especially hyperkalemia and renal tubular acidosis
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Disorders of electrolyte homestasis
AFFILIATED CLINICAL SITES:
Western New England Renal and Transplant Associates was formed in 1996 to provide completely coordinated outpatient and inpatient care in nephrology at
Pioneer Valley Dialysis is the flagship dialysis facility for Western Massachusetts to which patients from Baystate Medical Center receive dialysis care. Patients requiring admission are admitted to Baystate Medical Center to the renal inpatient transplant and dialysis floor. Each fellow will be assigned one dialysis shift per week of hemodialysis patients at Pioneer Valley Dialysis with an attending nephrologist also assigned who is responsible for the care of those patients. This will allow the fellows to have complete continuity in caring for patients on his/her dialysis shift. Peritoneal dialysis patients will be seen for three hours one half day per month.
Interested applicants for 2006 should contact Gail Wall for additional information and application.
Interested applicants for 2007 should apply through the Electronic Residency Application Service (ERAS)
Fellows must have completed a three year ACGME accredited program in internal medicine or a medicine/pediatrics program. Salary and benefits are set by Baystate Medical Center.
Program Director:
Gregory L. Braden, MD
For any questions regarding the fellowship program, please contact:
Gail Wall
Baystate Medical Center
759 Chestnut Street, S2570
Springfield, MA 01199
(413) 794-1155 (phone)
(413) 794-8075 (fax)
Email: gail.wall@bhs.org