University of Virginia Health System

1. To provide a comprehensive and longitudinal clinical experience in the care of patients on peritoneal dialysis
2. To provide an understanding of the principles and practice of peritoneal dialysis including the indications, contraindications, complications, cost-effectiveness, and application of PD to patient care (see topics below)
   
   

Over the course of 2 years of fellowship, the following topics related to peritoneal dialysis will be covered by a combination of didactic and clinical experiences, including case management conferences, lectures, journal club discussions, workshops, and direct patient care in both the inpatient and outpatient settings. Clinical experiences will entail supervised involvement in decision-making for patients undergoing PD. Opportunities for fellows to pursue an in-depth investigation of specific topics in peritoneal dialysis also exist through clinical research (ongoing and future) with the Director of the PD Program (Dr. Jean Holley).

1. Peritoneal physiology, including the small solute clearance and ultrafiltration
2. The history of peritoneal dialysis
3. Evaluation and selection of patients for PD (CAPD, CCPD) and their instruction about treatment options
4. Assessing adequacy of peritoneal dialysis and implications of adequacy related to patient morbidity and mortality, transporter status, peritoneal equilibration tests, residual renal function, KDOQI standards; dialysis prescriptions and their modifications to achieve adequate dialysis
5. The short and long-term complications of peritoneal dialysis, including the pathogenesis and prevention of complications including but not limited to: peritonitis, catheter infections, leaks, hernias, sclerosing peritonitis, nutritional and metabolic issues, hemoperitoneum
6. Placement and maintenance of peritoneal catheters and available catheters for use and how to choose appropriate catheters; the appropriate radiologic procedures for evaluating PD catheters
7. Peritoneal dialysis solutions-composition, biocompatibility, side effects
8. An understanding of the technology of peritoneal dialysis, including the use of automated cyclers (CCPD); principles of peritoneal biopsy
9. The pharmacology of commonly used medications and their kinetic and dosage alteration with peritoneal dialysis; drug dosage modification during peritoneal dialysis
10. An understanding of the special nutritional requirements of patients undergoing peritoneal dialysis; urea kinetics and protein catabolic rates in PD patients; nutritional management of PD patients
11. The quality of life of patients on peritoneal dialysis; psychosocial and ethical issues in PD patients and their families
12. The function of the nephrologist in the collaborative practice of peritoneal dialysis including aspects of quality assurance in PD and the function of a Medical Director in PD programs

In order to provide each fellow with a longitudinal experience in the care and management of outpatients on PD, each fellow will follow at least 3-4 patients throughout the fellow's 2 year training period. The fellow will see his or her patients in routine PD clinic visits at least every other month and will be directly supervised by the Medical Director of the PD program during these clinic visits. Fellows will thus be trained in the above clinical topics and gain an appreciation for the evolving issues related to PD (e.g., loss of residual renal function and its effect on dialysis adequacy). Fellows will participate in the development of both short and long-term care plans for their patients. All outpatient experiences will involve supervised decision-making for patients.

Patients with chronic kidney disease who are followed in Nephrology Clinic and choose PD when renal replacement therapy is required will continue to be followed by the same fellow when the patient is on PD.

While rotating on the chronic inpatient service, fellows will prescribe PD for chronic PD patients who are hospitalized. The use of PD in the setting of acute renal failure will also be part of each fellow's training.

Fellows have access to the following references through the library and the Medical Director's personal library:

• Gokal R, Nolph KD, eds. Textbook of Peritoneal Dialysis
• Khanna R, Nolph, KD, Oreopoulos DG. The Essentials of Peritoneal Dialysis
• Daugirdas J, Ing T. Handbook of Dialysis, second edition KDOQI Guidelines for PD
• KDOQI Guidelines for PD
• Peritoneal Dialysis International (bimonthly journal devoted to PD)