3. Yes
What are challenges/barriers?
No
Does the nephrology career require interventional
training as part of the training curriculum?
Yes
Is the training environment ready to accept
extracurricular commitment?
No
Is it a recognized subspecialty in Renal Medicine?
4. USA NI System
ASDIN: in 2000, now with well over 700 members
Sponsors annual meeting
Courses and bursaries
Guidelines
5. Drivers of Interventional
Nephrology
Expansion of dialysis services
Delayed appropriate treatment
Vascular access problems are negligible compared
to others services: surgeons and radiologists
Mostly outside the hospitals with lack of
standardization and questions about quality of
care
6. Scope of Interventions
US guided renal biopsy
Peritoneal dialysis catheter insertion
Tunnelled dialysis catheters
Endovascular procedures for dysfunctional AVF or
grafts
7. Requirements
Efficacy
14000 procedures done by IN, 96% success
(Beathard 2004)
Safety
Of the same study 4% complications
Appropriate Training
8. Ultrasound
Essential for renal procedures but important
diagnostic tool
OPD US waiting is reduced from 46 days to 4 days
when done by renal (Asif et al 2003)
Clinical correlation is crucial to interpret images
and address renal questions
9. Pros
Expeditious care
Patient/operator familiarity
Seamless communication
Achieving superior outcomes
Prospective planning of future VA
Opportunity for innovation and research
10. Haemodialysis Catheter
27% HD in the states use catheters
With IN number of hospitalization because of
vascular access and number of missing dialysis
sessions reduced significantly (Mishler et al 2006)
Cost saving linked to OPD versus inpatient
approach
15. Cons
Limited workforce
Limited training opportunities
Interventional “turf” issues
IN could be divisive and polarizing
Quality control
16. Conclusions
Does the Health Care system In Egypt requires
this initiative?
Do you think the current environment support
this initiative?
Local Barriers, challenges
