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Fellows participate in clinical activities within the Divisions of Nephrology at Tufts Medical Center and our sister institution Caritas-St. Elizabeth’s Medical Center.
Clinical Activities at Tufts-New England Medical Center
Tufts Medical Center is a tertiary care center located in the heart of Boston’s Chinatown district that serves as the principal teaching hospital for Tufts University School of Medicine. The Division of Nephrology focuses on four areas of clinical nephrology at Tufts Medical Center. These are Inpatient Consultation, Transplantation, Outpatient Consultation, and Outpatient Dialysis.
Inpatient Nephrology Consultation
The nephrology consultation service includes a staff physician, a fellow, housestaff, and one or more fourth-year medical students. In general, two to four requests for consultation are received daily regarding acute renal failure, acid-base and electrolyte disorders, hypertension, chronic kidney disease, and medical problems arising in patients with end-stage renal disease. Consults are discussed daily in afternoon rounds. Fellows are trained to place internal jugular and femoral venous access catheters, and perform hemodialysis, peritoneal dialysis, and continuous venovenous hemofiltration. In addition, fellows do 30 to 50 percutaneous kidney biopsies each year.
Approximately sixty living-donor and deceased-donor kidney transplantations are performed annually at Tufts Medical Center. Dr. Ronald Perrone is the Medical Director of Kidney Transplantation. Fellows participate in all phases of patient care, including pre-transplant selection and evaluation of recipients and living-donors, post-operative care, and treatment of rejection and other complications of immunosuppression. Following discharge, transplant recipients receive primary medical care in the Kidney and Blood Pressure Center. The transplant fellow and a staff physician are responsible for the care of all hospitalized kidney transplant recipients. In addition, the transplant fellow performs nephrology consultations on all inpatient liver, heart, lung, and bone marrow transplant recipients as requested. The fellow interacts daily with members of the Transplant Surgery team, which includes three staff surgeons. Multi-disciplinary work rounds are held weekly with the Transplant Surgery service, at which time prospective donors and recipients are discussed, the progress of both inpatients and outpatients are reviewed, and treatment plans are formulated.
The Kidney and Blood Pressure Center at Tufts Medical Center has provided consultations since 1950, and now has the busiest outpatient nephrology practice in the area. Dr. Scott Gilbert is the Medical Director. Patients are seen in one of nine weekly nephrology clinics. There are approximately 3000 active patients in the clinics, with 250 new referrals and 4000 return visits each year. The outpatient practice includes consultation on patients referred for a wide variety of kidney and blood pressure disorders, as well as the longitudinal care of patients with chronic kidney disease, kidney transplants, and end-stage renal disease on home dialysis or peritoneal dialysis. Patients are seen at each clinic visit by a fellow, and then jointly with a staff nephrologist. The fellows provide continuity of care for the duration of their training. To allow fellows to concentrate on the issues at hand, coverage of inpatient emergencies is provided during clinic sessions. A full-time nurse coordinates clinic activities, and a full-time medical assistant/phlebotomist is available.
The Division’s outpatient dialysis facility is operated by Dialysis Clinic, Inc., a national nonprofit corporation. Dr. Klemens Meyer directs the dialysis program. The facility currently serves about 100 hemodialysis patients. These include high-functioning dialysis patients who live in the neighboring community, patients undergoing evaluation for home dialysis and transplantation, and other patients with complex medical and social needs requiring a tertiary care setting. Clinical fellows serve as each patient’s primary physician, with close supervision by Drs. Meyer, Weiner, Balakrishnan, Gilbert, Khan, Perrone, and Sarnak. Vascular and peritoneal access surgery is performed by the Transplant Surgery service. A multi-disciplinary team, including nurses, a social worker, a nutritionist, fellows, and attending staff, meets weekly to review each patients’ progress. In addition, a weekly multidisciplinary vascular access conference is held with representatives from nephrology, transplant surgery, interventional radiology, and the vascular flow lab.
Tufts Medical Center’s peritoneal dialysis program was the first in Boston. Patients are trained by a peritoneal dialysis nurse, in collaboration with the fellows and attending staff. After training is complete, patients are seen monthly for follow-up visits in the Kidney and Blood Pressure Center.
Clinical Activities at Caritas-St. Elizabeth’s Medical Center
Fellows spend between three and four consecutive months during their training at Caritas-St. Elizabeth’s Medical Center. St. Elizabeth’s a 350-bed teaching hospital located a few miles from Tufts Medical Center. It is one of the major teaching resources of Tufts University School of Medicine, providing training each year to 100 housestaff, a third of the Tufts medical students, and fellows in many clinical areas. The hospital serves as both a tertiary referral center and a community resource, and offers a full range of clinical services including cardiac surgery and the largest hospital-based dialysis program in Boston. The fellow’s experience is designed to provide a broad exposure to Nephrology in a community hospital setting. Fellows are expected to manage an inpatient Nephrology service, a Nephrology consultation service, an outpatient hemodialysis population, and see outpatients in a weekly clinic. Fellows also play a role in teaching medical students and housestaff, and are responsible for preparing a weekly fluid-electrolyte conference. Fellows participate in kidney biopsies and all dialysis procedures, including CAVH and CVVHD. The Nephrology staff at St. Elizabeth’s is renown for high quality of teaching.
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