The Evolution of Critical Care Nephrology in Edmonton

Abstract

The University of Alberta (UofA) in Edmonton, Canada has a rich and productive history supporting the development of critical care medicine, nephrology and the evolving subspecialty of critical care nephrology. The first hemodialysis program for patients with chronic renal failure in Canada was developed at the University of Alberta Hospital. The UofA is also recognized for its early pioneering work on the diagnosis, etiology and outcomes associated with acute kidney injury (AKI), the development of a diagnostic scheme renal allograft rejection (Banff classification), and contributions to the Renal Disaster Relief Task Force. Edmonton was one of the first centers in Canada to provide continuous renal replacement therapy. This has grown into a comprehensive clinical, educational and research center for critical care nephrology. Critical care medicine in Edmonton now leads and participates in numerous critical care nephrology initiatives dedicated to AKI, renal replacement therapy, renal support in solid organ transplantation, and extracorporeal blood purification. Critical care medicine in Edmonton is recognized across Canada and across the globe as a leading center of excellence in critical care nephrology, as an epicenter for research innovation and for training a new generation of clinicians with critical care nephrology expertise.

Nephrologists Rather Than Intensivists Should Manage Kidney Replacement Therapy in the ICU: CON

“…The middle ground and the mystical "unicorn" we are searching for to lead may simply be the engaged nephrologist or intensivist who has undertaken focused clinical training in both disciplines and remains wholeheartedly committed to the subspecialty of critical care nephrology in the ICU, both clinically and academically. Although dual training and certification in both disciplines is now relatively common, 16 this may not always be practical or welcome.…”

“…Although this may seem extreme, I would hazard that in many jurisdictions, aspects of both these scenarios manifest not infrequently. Surely there must be some middle ground, whereby again, the patient is the central tenet of care 16 (Table 1).…”

The need for disruptive innovation in acute kidney injury

“…Moreover, for this multidisciplinary team development, they suggested a structure of training and patient care for critical care nephrology. An excellent training program on critical care nephrology is available at Alberta University, Edmonton, Canada [ 76 ]. The Acute Dialysis Quality Initiative (ADQI) Group, which suggested the RIFLE criteria [ 9 ], consisted of both intensivists and nephrologists [ 8 ].…”