Getting diagnosed with chronic kidney disease is life-changing and the amount of information you receive about your condition can be overwhelming, including the types of health care professionals you will have as part of your care team. You will be communicating with physicians, nurses, lab technicians, dietitians, social workers and more.
You may already be familiar with your nephrologist, a physician who specializes in the diagnosis and treatment of kidney disease, but have you heard of an interventional nephrologist? If you haven’t yet, you may in the near future if dialysis is part of your treatment plan. It can help to understand how these specialists differ from nephrologists. Read on to learn more about each of these physicians and their roles in your kidney disease care.
What Is a Nephrologist?
Patients who have kidney disease, or who are at risk for kidney disease in the future, are often referred to a nephrologist. A nephrologist is a doctor who specializes in health conditions affecting the kidneys. (i) Nephrologists first train in internal medicine and then complete a fellowship in nephrology.
These doctors resolve many kidney issues through prescription medication or lifestyle changes. A nephrologist can also guide patients through the process of arranging for a kidney transplant and, if needed, starting dialysis. The nephrologist will play a major role in managing and overseeing the patient’s care during ongoing dialysis treatments.
Nephrologists may also work with patients who have certain chronic health conditions such as diabetes, hypertension, and autoimmune disorders, which may contribute to kidney disease. (ii) Nephrologists can help their patients preserve adequate kidney function for as long as possible.
Once a patient enters end-stage renal disease (ESRD), their nephrologist can oversee the following aspects of their medical care: (ii)
- Blood pressure management
- Kidney biopsy
- Kidney transplant
- AV graft/AV fistula placement
- AV graft/AV fistula management
- Dialysis
Nephrologists often prescribe medications, recommend procedures, and supervise a patient’s general treatment for kidney disease (iv) but a nephrologist may not have the training to perform all kidney disease-related procedures. (v) They may arrange for a surgeon to perform a kidney biopsy, or for a radiologist to perform kidney imaging tests.
What Is an Interventional Nephrologist?
Interventional nephrology is a subspecialty of nephrology requiring practical knowledge of percutaneous endovascular procedures to manage dysfunctions of a vascular access in ESRD patients. (iii) Interventional nephrologists undergo specialized training and perform many procedures, including dialysis access creation and dialysis access management, which may involve angioplasty, stenting and thrombectomy. This type of hands-on treatment allows for a better understanding of dialysis patients’ needs and more personalized care. (iii)
The Intersection of General Nephrology and Interventional Nephrology
Patients with ESRD may want to see both a nephrologist and an interventional nephrologist. Typically, nephrologists oversee their patients’ long-term treatments, like dialysis and kidney transplants, and can also help their patients control any other chronic health conditions and manage their prescription medications. (ii) Many interventional nephrologists choose to focus on interventional care. There are instances where an interventional nephrologist also serves as the primary nephrologist for their patients.
During their treatments for ESRD, patients might also work with an interventional nephrologist at several points. These doctors perform endovascular procedures that dialysis patients need to keep their vascular access fully functional for the most effective dialysis treatments. (iii)
Once patients have undergone these endovascular procedures, they’re able to continue with the treatments recommended by their nephrologist. Nephrologists and interventional nephrologists work together to develop a joint treatment strategy that ensures ESRD patients receive the best care possible. Besides their nephrologists, ESRD patients usually have a whole team of providers who are in charge of different aspects of their medical care. (i)
Should I See an Interventional Nephrologist?
Interventional nephrology may not be necessary for all kidney disease patients. Patients who are not on dialysis and don’t need specialized radiology procedures may be well cared for by a general nephrologist.
If you’re not sure where to find an interventional nephrologist in your area, a vascular access center might be a good place to start your search.
Where Do Dialysis Patients Receive Care for Their Vascular Access?
If you’re under the care of a general nephrologist, he or she may send you to a dialysis center once it’s time for you to begin dialysis. (vii) Dialysis centers are specialized clinics: patients at these centers only receive dialysis services.
Vascular access centers are different. They don’t offer dialysis, but they do provide a wide range of medical services to ensure the patency and function of the vascular access. Dialysis patients may visit a vascular access center for help managing their dialysis access or for treatment of access complications.
Develop a Dialysis Treatment Strategy
Many dialysis patients seek treatment at both dialysis centers and vascular access centers. A vascular access center can place your dialysis access and help with dialysis access management. You will need a nephrologist and a dialysis center for dialysis treatments.
The main advantage of vascular access centers is the opportunity to consult with vascular specialists, like interventional nephrologists. If your vascular specialist decides that you would benefit from a certain procedure, you can often receive that procedure right there in that location. There’s no need to travel to a different location or work with an unfamiliar specialist: your interventional nephrologist can personally oversee your dialysis access care every step of the way.
Making decisions about dialysis treatment isn’t easy. Dialysis patients often have many questions about which treatment options are best and how to care for their access at home. Azura Vascular Care offers a free guide, Understanding Your Dialysis Access, which covers these critical topics. Download the free guide now, or call (866) 996-9729 today to schedule an appointment with a vascular specialist.
Sources:
(i) National Kidney Foundation. (2016, July 25). Your dialysis care team. Retrieved October 11, 2018, from https://www.kidney.org/atoz/content/dialcareteam
(ii) Stanford Health Care. (n.d.). Care and treatment of kidney disorders. Retrieved September 24, 2018, from https://stanfordhealthcare.org/medical-clinics/nephrology-kidney-clinic/conditions.html
(iii) Efstratiadis, G., Platsas, I., Koukoudis, P., & Vergoulas, G. (2007). Interventional nephrology: A new subspecialty of nephrology. Hippokratia, 11(4), 22-24. Retrieved September 24, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464263/.
(iv) Fresenius Kidney Care. Your hemodialysis treatment team. Retrieved October 8, 2018, from https://www.freseniuskidneycare.com/ckd-treatment/in-center-hemodialysis/treatment-team.
(v) Berns, J. S., & Oneill, W. C. (2008). Performance of procedures by nephrologists and nephrology fellows at U.S. nephrology training programs. Clinical Journal of the American Society of Nephrology, 3(4), 941-947. doi:10.2215/cjn.00490108
(vi) MedPage Today. (2014, November 05). Nephrologists take fistulas into their own hands. Retrieved September 24, 2018, from https://www.medpagetoday.com/Nephrology/GeneralNephrology/45696
(vii) MedlinePlus. (2018, January 16). Dialysis centers – what to expect. Retrieved September 24, 2018, from https://medlineplus.gov/ency/patientinstructions/000706.htm
