Services for Patients, Families and Physicians
Chronic Kidney Disease (CKD) Program
Early intervention and education are critical to slowing the progress of kidney disease. The CKD program offers the complete management of a patient, involving the regular monitoring of kidney function, blood pressure and/or blood glucose levels and cardiovascular risk factors; the management of anemia and the measuring of bone and mineral metabolism. Patients usually require multiple medications, including insulin or other hypoglycemic medications; two to three antihypertensive medications; erythropoietin injections; oral binding agents for high-phosphate, vitamin D analogs; cholesterol-lowering agents and antiplatelet agents. Patients also need special individually tailored dietary counseling and education. Our CKD addresses all these needs.
Kidney and Pancreas Transplant Program
The Transplant Program is staffed by four transplant surgeons, six full-time nephrologists, four transplant program coordinators, a transplant social work specialist and a transplant financial counselor. Over the past four years, about 50 percent of patients on the waiting list received a transplant within one year due to aggressive management of patient data. This exceeds the national average by fourfold.
Since the program was established in 1964, there have been a total of over 600 kidney transplants, including over 125 living donor transplants and nearly 500 cadaveric kidney transplants. In 2004 the program was expanded to include pancreas and simultaneous pancreas-kidney transplants.
Recent innovations by the Transplant Program include the introduction of laparoscopic kidney removal for live donors, the introduction of the cadaveric adult-to-adult dual-kidney transplant and the establishment of an Altruistic/Non-Directed Living Kidney Donation Program.
Acute Dialysis Service
The nephrology staff also directs the acute hemodialysis procedure. These services are often provided in intensive-care settings and supervised by the attending physician on the Inpatient Nephrology Medical Service or the consult service. Treatments are sometimes required for patients with drug overdoses or intoxication, but mostly for patients with new acute renal failure or acutely ill patients with chronic renal failure. There are an average of 150 treatments monthly; more than 30 of them are performed bedside, usually in an intensive-care-unit setting.
Chronic Dialysis Service
Approximately 50 patients with end-stage renal disease receive their maintenance dialysis treatment in the Transplant Unit. The focus of the unit is to provide dialysis treatment to a unique group of patients who are not suited for care in freestanding dialysis units. Typically, these patients have multiple medical problems or marginal vascular access, are recently diagnosed or are residents of the nursing home located inside the medical center.
Vascular Access Program
This integrated program under the direction of Dr. Brian Murray includes medicine, surgery and radiology. The program is coordinated by a full-time nurse practitioner and sees 250–300 patients annually to monitor the surgically implanted access needed for dialysis. The program has markedly reduced the need for emergency catheter placement for dialysis.
Dr. Murray has been awarded a grant to study a new device that measures the blood flow in the vascular access to assess a partial occlusion. This effort—funded by the National Institute of Health—is being done in cooperation with Transonic Systems of Ithaca, New York.
Surgery is also available for those patients who need catheter placement for dialysis. The access surgery is performed by several full-time staff physicians. Catheter placement used for shorter-term dialysis access is performed by members of the invasive radiology and surgery staff.
The Renal/Hypertension Clinic, staffed by three nephrologists and one or two nephrology fellows, is held weekly. Patients are referred from ECMC's health network as well as other providers, including the Veterans Administration Medical Center and other local health systems. The clinic serves all patients regardless of their ability to pay, providing more than 800 consults annually.
Inpatient Medical Services
ECMC's nephrology patient population has expanded and is now large enough that one of the University at Buffalo–ECMC Internal Medicine inpatient services comprises nearly exclusively patients with renal disease as their primary underlying or acute medical problem. The service typically serves 12–15 inpatients and is characterized by rapid turnover.
Transplantation Outpatient Service
The evaluation of potential recipients and care of patients after transplantation is a major commitment of the nephrology team, despite the fact that many of these visits are complex and time-intensive. In 2004, for example, there were almost 2,400 visits to the transplant service.
Consultations are available to all inpatient services, including transplanted patients who are on surgery service. This service is typically directly involved in the care of 20–25 inpatients and averages more than one new consult daily, not including "one-day surgery" admissions for renal biopsies and renal angiograms.
Outpatient Nephrology Consults
Each member of the nephrology staff has at least one clinic session weekly. These "private clinics" provide consultative nephrology service to referring physicians throughout Western New York and occasionally from expanded geographic sites. Such patients are often potential candidates for the chronic kidney disease clinic, dialysis or even a transplant.
Medical Complication of Pregnancy
Outpatient consultation is provided to the obstetric community for women suffering from hypertension and renal disease during pregnancy. Inpatient consults are regularly undertaken at Women and Children's Hospital and Sisters of Charity Hospital.
Clinical and Translation Research
The Department of Nephrology has a long-standing reputation for clinical research. The research involves all areas of the specialty, but transplantation-related studies have had the highest profile both in the number of reports and national recognitions.
We currently have active grants from the federal Health Resources and Services Administrations (HRSA), the federal National Institutes of Health (NIH), pharmaceutical manufacturers and the State University of New York at Buffalo; a major new NIH request was recently submitted. The new initiative to the NIH has a substantial element of genetic testing, with a focus on pharmacogenomics.
We have also applied to become one of the newly designated centers of excellence of the university. Along with the School of Pharmacy, we hope to develop a specialized center for pharmacogenomics and pharmacokinetics at ECMC.
A cornerstone for clinical care and expanded clinical research is the recently funded John R. Oishei Foundation grant to purchase and install an advanced computer database software program to manage both our clinical and research efforts.