Incorporating Training in POCUS in Nephrology Fellowship Curriculum

Reisinger, Nathaniel; Koratala, Abhilash

doi:10.2215/cjn.09580822

Cited by 7 publications

(8 citation statements)

References 10 publications

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“…Applications such as Doppler echocardiography, VExUS, and E-VExUS require solid technical skills that can only be garnered by longitudinal training. Especially in nephrology, there are a very few fellowship programs that offer training in comprehensive hemodynamic assessment at this time[ 56 , 57 ]. This is ironic given that most of the consults in a typical nephrology practice revolve around managing fluid disorders.…”

Section: Knowledge Gaps and Future Directionsmentioning

confidence: 99%

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Turk¹,

Robertson²,

Koratala³

2023

World J Crit Care Med

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Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.

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Section: Knowledge Gaps and Future Directionsmentioning

confidence: 99%

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Turk¹,

Robertson²,

Koratala³

2023

World J Crit Care Med

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“…Recently, a national survey of nephrology fellows and training program directors demonstrated that point-of-care ultrasound (POCUS) is starting to fill that role with 38% of nephrology trainees reporting some form of POCUS education [36 ▪▪ ]. More investment is needed on the part of fellowships with only one third of those fellows reporting POCUS training feeling confident in performing POCUS [37 ▪ ]. Indeed, while only 23% of training program directors reported having a POCUS curriculum in place, 95% of those remaining had an active plan for building a program.…”

Section: Training In Clinician-performed Ultrasound: An Unmet Needmentioning

confidence: 99%

“…However, there is reason for optimism despite limited resources: innovative and proven curricula exist. We have published extensively on our experiences building clinical ultrasound curricula and there are off-the-shelf products available for immediate clinical integration [37 ▪ ,40,41]. We have put together dozens of intense and immersive clinical ultrasound workshops at major conferences across the globe to quickly scale up attendee hands-on and visual pattern-recognition skill [37 ▪ ].…”

Section: Training In Clinician-performed Ultrasound: An Unmet Needmentioning

confidence: 99%

“…We have published extensively on our experiences building clinical ultrasound curricula and there are off-the-shelf products available for immediate clinical integration [37 ▪ ,40,41]. We have put together dozens of intense and immersive clinical ultrasound workshops at major conferences across the globe to quickly scale up attendee hands-on and visual pattern-recognition skill [37 ▪ ]. Further, social media can be harnessed as a force multiplier in clinical ultrasound education, allowing rapid training of personnel and allowing for remote crowd-sourced quality assurance [42 ▪ ].…”

Section: Training In Clinician-performed Ultrasound: An Unmet Needmentioning

confidence: 99%

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Current opinion in quantitative lung ultrasound for the nephrologist

Reisinger,

Koratala

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Volume overload mediates worse cardiovascular outcomes in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), leading to increased acute care utilization. Understanding the presence of pulmonary congestion, which is often clinically silent, could be instrumental in predicting acute care needs and mitigating risks through appropriate therapy. This review provides an overview of the existing literature on lung ultrasound in ESKD patients. Recent findings Quantitative lung ultrasound predicts adverse cardiovascular outcomes in ESKD patients on HD. The largest randomized controlled trial of a lung ultrasound-guided ultrafiltration strategy demonstrated control of pulmonary congestion without an increased risk of intradialytic hypotension, arrhythmia, or access thrombosis. Despite this, the study was negative in the incidence of the primary composite endpoint of all-cause death, nonfatal myocardial infarction, and decompensated heart failure. A post hoc analysis showed promise with reductions in recurrent acute care utilization and cardiovascular events. Recent research has focused on simplification of the 28-zone lung ultrasound, and abbreviated protocols have been shown to retain prognostic ability. Summary Lung ultrasound is a valuable tool for nephrologists to diagnose and manage pulmonary congestion. However, its optimal integration with other hemodynamic parameters to formulate effective management strategies remains elusive. Future studies should address these gaps and find solutions to the training inadequacies in clinician-performed ultrasound.

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“…According to a 2020 survey, 57% of the responding United States medical schools (69 out of 122) integrated POCUS instruction into undergraduate medical curriculum[ 2 ]. Once confined to procedural guidance such as dialysis catheter placement, the scope of POCUS in nephrology has now greatly expanded to include a wide array of diagnostic applications ranging from kidney ultrasound to focused echocardiography[ 3 , 4 ]. Some nephrology fellowship programs have even incorporated detailed hemodynamic monitoring using advanced Doppler techniques into their curricula[ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Point of care ultrasonography in onco-nephrology: A stride toward better physical examination

Bhasin¹,

Koratala²

2023

World J Nephrol

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Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.

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Incorporating Training in POCUS in Nephrology Fellowship Curriculum

Cited by 7 publications

References 10 publications

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Current opinion in quantitative lung ultrasound for the nephrologist

Point of care ultrasonography in onco-nephrology: A stride toward better physical examination

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