Clinical Operations

Inpatient Consultation Service

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 provide outpatient consultative care at 5 different locations in Charlottesville (2), Orange, Zions Crossroads and Fishersville. The Kidney Center Clinic is located within the campus and near the university hospital. Eight full-time faculty members, as well as fellow physicians provide care to over 4,500 (?) individuals with different kidney diseases each year. The Piedmont clinic located in the Pantops area was opened to improve patient access to UVA faculty in Charlottesville.

In 2018 an onconephrology clinic became operational at the Emily Couric center, where our faculty see patients with kidney disease associated with different types of cancer or resulting from cancer treatment. In 2019 we added a stone clinic at the Kidney Center clinic in Charlottesville.

The University of Virginia owns and operates 11 hemodialysis clinics throughout central Virginia, caring for nearly 1000 individuals with end stage kidney disease. All dialysis modalities are offered including sizeable peritoneal and home hemodialysis populations. UVA patients benefit from having all stages of kidney care – Chronic kidney disease, dialysis therapy and transplant, within one organization to provide a care continuum. 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 incident dialysis transitions and the application of machine learning (artificial intelligence) technologies to improve medication dosing. The dialysis program is an essential component of fellowship training. Nationally recognized social workers, dieticians, nurses and dialysis techs provide a strong interdisciplinary team from which to 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 lots of benefits to patients with end stage kidney disease (ESKD). UVA offers that important alternative to its patients.

HHD team at UVA includes a dedicated RN, social worker, a dietician and a nephrologist. Patients interested in this modality receive 4-6 weeks training on this modality by a one-on-one expert RN. This training occurs at the UVA main campus in Charlottesville. Once patients are comfortable with this modality, they go home with an iPAD to allow monitoring patients while dialyzing and are seen in the clinic once monthly by the HHD team.

Four UVA faculty and 5 nephrology RN dedicate their efforts to the care of about 70 peritoneal dialysis (PD) patients in two clinics in Charlottesville and Staunton.  Our staff have been instrumental in training nurses at the university hospital, local rehabilitation hospitals and nursing homes in the care of PD patients. Our PD program is dedicated to remodeling dialysis delivery with urgent start PD program and 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. Six (soon to be seven) 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 cover the apheresis for all the solid organ transplant recipients. Our team helps manage the HLA lab under the leadership of Dr. Lobo. The transplant nephrology service also covers kidney and electrolyte consults from the other solid organ transplant services. We have an ATC certified transplant fellowship. Fellows rotate through evaluation, post-transplant clinics and the busy inpatient service. Fellows have the option to join us in outreach across the Commonwealth and participate in other transplant specific areas such as the HLA lab, transplant donor evaluations, QAPI meetings, and protocol review.

The transplant department has a clinical research program with coordinators and a number of funded projects. We hold a monthly transplant research meeting that trainees are welcome to participate in and collaborate on projects.