Clinical Operations

UVA patients receive expert attention for all stages of kidney care – acute and chronic kidney disease, dialysis therapy and transplant along with patient and nutrition support services – to provide continuum of care.

The inpatient nephrology operations include general nephrology, ICU nephrology and transplant nephrology consultative services run by clinical fellow physicians and staffed by full-time UVA faculty with expertise in each field. The inpatient Renal Unit is staffed by 30 registered nurses and provides 24-hour extracorporeal therapies to patients who are admitted to the university hospital. We perform about 5,000 hemodialysis, 2,000 continuous renal replacement therapy, 600 peritoneal dialysis and 800 therapeutic apheresis treatments at the university hospital each year.

The Division of Nephrology faculty members and fellows provide outpatient consultative care in Charlottesville, Orange, Zion Crossroads and Fisherville. The Kidney Center Clinic is located in Charlottesville within the campus and near the university hospital. The Piedmont clinic, located in the Pantops area, was opened to improve patient access to UVA faculty in Charlottesville. Full-time nephrology faculty members, as well as nephrology fellows, physicians, nurses, nurse practitioners, social workers, and nutritionists, provide care each year to over 4500 individuals with kidney diseases.

We have several specialty clinics, including:

  • Onconephrology clinic at the Emily Couric Cancer Center, where our faculty and fellows see patients with kidney disease associated with different types of cancer or resulting from cancer treatment.
  • Kidney stone clinic at the Kidney Center Clinic in Charlottesville.
  • Glomerulonephritis clinic at the Kidney Center Clinic.
  • Cardiorenal Clinic

The University of Virginia owns and operates 11 hemodialysis clinics throughout central Virginia, caring for over 900 individuals with end stage kidney disease. Locations and contact information can be found at our Kidney Care web site. All dialysis modalities are offered including care for patients requiring peritoneal and home hemodialysis. Dialysis patients also benefit from access to clinical trials via integration with the UVA Nephrology Clinical Research Center. Several research and quality improvement programs remain ongoing and center on efforts to improve patient care and the patients’ experience as they transition into dialysis or transplantation; this program is facilitated by the application of machine learning (artificial intelligence) technologies to improve medication dosing during dialysis. The dialysis program is an essential component of fellowship training. Social workers, dieticians, nurses and dialysis technicians provide a strong interdisciplinary team to serve the needs of patients and to help nephrology fellow trainees develop the essential skills of caring for dialysis patients. In addition, the large historical database of over 3,000 patients and detailed medical records provides an excellent resource for data-driven research papers.

 

Home hemodialysis (HHD) is an underutilized dialysis modality that offers personalized treatment options for some patients with end-stage kidney disease. UVA offers this important alternative to its patients.

The HHD team at UVA includes a dedicated registered nurse (RN), social worker, a dietician, and a nephrologist. Patients interested in this modality receive 4-6 weeks of one-on-one training on this modality with a specially trained HHD RN. This training occurs at the dialysis clinic on the UVA campus in Charlottesville and in the Lynchburg dialysis clinic. Patients who are at home on HHD are closely monitored by the HHD team and are seen in the clinic monthly.

UVA Nephrology faculty members and nephrology registered nurses dedicate their efforts to the care of about 70 peritoneal dialysis (PD) patients in clinics in Charlottesville, Lynchburg, and Staunton.  Our staff have trained nurses at the University hospital and in local rehabilitation hospitals and nursing homes in the care of PD patients. Our PD program is dedicated to remodeling dialysis delivery with an urgent start PD program, telemedicine, education of the next generation of nephrologists through a home dialysis focused curriculum, and research.

In 2018, 145 kidney and pancreas transplantations were performed at UVA hospital. This number increased to about 190 in 2019.  Our transplant nephrologists provide care to over 1000 prevalent transplanted patients and over 1000 new referrals per year in a large geographic area. We are known as a center for complex transplant care. We transplant high risk populations including extremely obese, HIV+, Hepatitis B and C+, dual liver-kidney, and dual heart-kidney patients. We provide apheresis for all the solid organ transplant recipients as needed. Our team helps manage the human leukocyte antigen (HLA) laboratory to provide full-service histocompatibility testing to match transplant recipients with compatible donor organs or tissues. The transplant nephrology service also covers kidney and electrolyte consults from the other solid organ transplant services. We have an ATC certified transplant fellowship program. Transplant fellows rotate through evaluation, post-transplant clinics and the busy inpatient service. Fellows have the option to join us in outreach across the Commonwealth of Virginia and participate in other transplant specific areas such as the HLA lab, transplant donor evaluations, QAPI meetings, and protocol review.

The UVA Nephrology transplant program conducts clinical research and has a number of funded projects. We hold a monthly transplant research meeting that welcomes trainees who would like to participate in and collaborate on projects.

Renal Social Workers

A diagnosis of chronic or end stage kidney disease can be overwhelming to patients and can bring unexpected challenges.  Renal social workers are highly trained individuals who provide a support system for patients and their families as they adjust to and learn about kidney disease, dialysis or a kidney transplant. The renal social worker is the patient’s advocate and provides a conduit for communicating with other members of the treatment team. Renal social workers work with the treatment team, and by presenting a full picture of all the patient’s needs, can help ensure that the best decisions are made regarding the patient’s overall health, well-being, and quality of life.

Renal social worker responsibilities include but are not limited to:

  • Meeting with the patient and family to evaluate needs and provide referrals, as needed
  • Helping patients and their family understand kidney disease, dialysis and kidney transplantation
  • Emphasizing the importance of a strong support system that includes family and other individuals
  • Discussing emotional needs and aiding in the development of coping mechanisms
  • Offering supportive counseling
  • Helping patients apply for financial assistance if needed
  • Providing assistance with keeping or obtaining insurance coverage
  • Offering guidance on adjusting to treatment plans, including dietary changes
  • Facilitating vocational rehabilitation services and/or offering support for maintaining employment, attending school, and continuing with activities that bring personal enjoyment
  • Identifying local resources for transportation, home health services or other needs
Nutrition Services

The University of Virginia Nutrition Services provides registered dietitians (RD) for all aspects of our patients’ kidney disease care.  Inpatient RDs assist as needed with any nutrition-related issues for acute kidney injury or chronic kidney disease during hospitalization.  In our outpatient clinics, dietitians are available for nutrition education for chronic disease kidney, diabetes, hypertension and any comorbid conditions that can be improved with healthy eating.  Each dialysis unit has designated dietitians that are available each week for nutrition counseling, monthly lab review and rounds, and for any individualized nutrition needs for patients receiving in-center hemodialysis.  Home hemodialysis and peritoneal dialysis patients will have a designated RD to support them at home and see them at appointments each month in our outpatient clinic and at other times as needed.

Additional information, including the location of outpatient and dialysis clinics, can be found on our UVA Kidney Care web site.