Clinical Operations

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. 30 registered nurses staff the inpatient Renal Unit and provide 24-hour extracorporeal therapies to patients admitted to the university hospital. Our faculty and nursing staff are experienced with a wide variety of extracorporeal treatment modalities, including volumetric and gravimetric continuous renal replacement therapy (CRRT) systems, slow, low-efficiency dialysis (SLED), slow continuous ultrafiltration (SCUF) and therapeutic apheresis (TA). We perform over 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, Culpeper, Lynchburg, Farmville, and Fishersville. The Kidney Center Clinic is located on campus in Charlottesville, near the university hospital. The Piedmont clinic in the Pantops area was opened to improve patient access to UVA faculty in Charlottesville. Full-time nephrology faculty members and nephrology fellows, physicians, nurses, nurse practitioners, social workers, and nutritionists provide care each year to over 4500 individuals with kidney diseases.

In addition to the general nephrology clinic, two subspecialty clinics have been established in collaboration with other specialties in internal medicine to provide better care to our patient population.

• In the onconephrology clinic at the Emily Couric Cancer Center, our faculty and fellow physicians with expertise in managing kidney and electrolyte disorders associated with cancer collaborate with oncologists (cancer specialists) at UVA.
• The glomerulonephritis clinic was established in collaboration with experts in the Division of Rheumatology. Kidney disease and rheumatology experts work together in this clinic to manage kidney disease caused by autoimmune diseases.

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 on our Kidney Care website. All dialysis modalities, including care for patients requiring peritoneal and home hemodialysis, are offered. 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 patient’s experience as they transition into dialysis or transplantation; this program is facilitated by applying 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 patients' needs and 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 provide an excellent resource for data-driven research papers.

For those who qualify, we consider home modalities of kidney (renal) replacement therapy the preferred choice and strongly encourage our patients to consider them. Our educational classes and one-on-one patient interactions emphasize the better quality of life and more independence associated with these modalities of dialysis.

The Home Dialysis Clinic at the UVA is staffed with experienced and dedicated nurses, nephrologists (kidney specialists), dietitians, and social workers.  Our fellow physicians participate in the care of these patients under the direct supervision of our faculty members.

UVA Nephrology faculty members and nephrology registered nurses dedicate their efforts to caring for about 70 peritoneal dialysis (PD) patients in Charlottesville, Lynchburg, and Staunton clinics. Our staff has trained nurses at the University Hospital and local rehabilitation hospitals and nursing homes to care for PD patients. Our PD program is dedicated to remodeling dialysis delivery with an urgent start PD program, telemedicine, and educating 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 yearly 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 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 can 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 reviews.

The UVA Nephrology transplant program conducts clinical research and has several funded projects. We hold a monthly transplant research meeting that welcomes trainees who want 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 support patients and their families as they adjust to and learn about kidney disease, dialysis, or kidney transplants. The renal social worker is the patient’s advocate and provides a conduit for communicating with other treatment team members. Renal social workers work with the treatment team, and 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 families 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
• Assisting 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 kidney disease, diabetes, hypertension, and any comorbid conditions that can be improved with healthy eating.  Each dialysis unit has designated dietitians available weekly for nutrition counseling, monthly lab reviews and rounds, and 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.

UVA Nephrology Attending Schedule