Clinical

 Division of Nephrology
CLINICAL ACTIVITIES

• UVA Dialysis Orange
• Nephrology Clinic at UVA Specialty Care
• Transplantation
• Transitional Extracorporeal Care Unit
• New Faculty Member Focused on Toxicology

As the Division of Nephrology’s reputation has grown over the last decade, so has its clinical practice and patient volumes. The division continues to provide substantial inpatient care on the general medicine wards and consultative services in nephrology at University Hospital, Augusta Hospital and Martha Jefferson Hospital.

Over the past three years, the division has added eight new clinical faculty to meet the increasing demands of a growing population of patients with kidney diseases. Faculty members have been recruited to enhance the division’s program in transplant nephrology, peritoneal dialysis, toxicology and general nephrology. The growth of the clinical activity is reflected in a 48.8 percent increase in revenue and 54.4 percent increase in work RVUs since 2005. On average, the wRVU volume has increased 5.0 percent each year since 2005.

The division has continued to expand its outreach through the establishment of new clinics and services in multiple locations in and around Charlottesville, providing care to patients from a wide swath of central Virginia and, through referrals, many more from elsewhere in Virginia and surrounding states — often for expert opinion; therapies, such as apheresis; and treatments, including experimental drugs, that are not available locally.

In the summer of 2014, UVA opened a new dialysis center in Farmville; the 9,800 square-foot, state-of-the-art facility has 20 dialysis stations — enough capacity to provide more than 18,000 treatments a year. Charles Brooks, MD, staffed the Farmville center during its first year of operation. It now has more than 60 patients.

UVA Dialysis Orange

UVA Dialysis Orange received one of the highest ratings for quality of care in the division’s system, both in regional and national rankings. This unit is under the medical directorship of Brendan Bowman, MD, who completed his fellowship training in nephrology at UVA; he has worked diligently with staff at the Orange facility to improve both care quality and patient engagement. He is now the regional director of UVA Health System’s dialysis program, overseeing the clinical operation of nine dialysis units. Dr. Bowman also serves as the associate director of the Nephrology Fellowship Program.

8 Dialysis Centers with 5-Diamond Status

During FY 2015, eight UVA dialysis centers serving more than 900 dialysis patients achieved “Five Diamond” status from the Mid-Atlantic Renal Coalition (MARC). (The recently opened Farmville facility has not yet been evaluated for “Five Diamond” status.) The MARC program includes training modules and resources to help dialysis facilities meet Centers for Medicare & Medicaid Services (CMS) standards for patient and staff safety; each certified facility must complete at least five training modules every year to maintain this status.

This is the third straight year that all of UVA Health System’s operating dialysis clinics have garnered a top patient-safety honor from the MARC program. Only 21 dialysis centers in Virginia have five-diamond status.

Additional Dialysis Centers Planned

The division is currently planning to build new facilities in the region as it continues to grow its services throughout Virginia. Together, the new facilities will be able to provide more than 14,000 treatments annually. Each facility is expected to employee 15 full-time staff members.

Nephrology Clinic at UVA Specialty Care Pinnacle Drive

UVA opened an outpatient nephrology clinic at UVA Specialty Care Pinnacle Drive in 2014 to operate in conjunction with UVA Dialysis Augusta. Clinic times were rearranged to allow improved access time for its doctors and nurse practitioners. This has led to a 28 percent increase in RVU generation from 3,657 RVUs (2014–2015) to 4,685 RVUs for 2015 as of June 1.

UVA Dialysis Augusta continues to rank as one of the best dialysis units in Virginia with regard to patient outcome measures; key measures are at or better than national benchmark goals, including:

• Arteriovenous fistula and catheter rates.
• Infection rates.
• Control of blood pressure and volume.
• Provision of adequate dialysis.
• Control of bone and mineral metabolism indicators.

There is improved patient compliance and decreased missed treatments, decreased hospitalization rates for congestive heart failure and volume overload, and improved patient satisfaction ratings for physician ratings in the 75th percentile or higher.

G. Adam Campbell, MD, assistant professor of medicine in the Division of Nephrology and section chief of nephrology at Augusta Hospital, is also medical director of dialysis and former chairman of the department of medicine at Augusta Hospital. He is joined at UVA Dialysis Augusta by the division’s newest faculty member, Tushar Chopra, MD, assistant professor of medicine. Dr. Chopra completed a fellowship in nephrology at Vanderbilt University and has a special interest in peritoneal dialysis; he will work closely with Dr. Campbell in order to build and expand the peritoneal dialysis program at Augusta. He will be involved in the development of effective continuous quality improvement programs in peritoneal dialysis, such as catheter problems, peritonitis rates and quality of life of patients and their families. In addition, he will expand training options for nephrology fellows in peritoneal dialysis therapy while attending on UVA’s inpatient nephrology service.

Monthly Treatments at Peritoneal Dialysis Units Up 27 Percent in 2015

In 2014, the division’s peritoneal dialysis (PD) units performed 1,423 treatments per month; one year later, that number had grown to 1,801 treatments per month, a 27 percent increase. As the program continues to grow at a robust pace, the staff is providing PD training to an average of six patients per month, and the program’s quality metrics continue to be outstanding, with peritonitis rates much lower than the benchmark. The PD program is directed by Mitchell Rosner, MD, FACP, Henry B. Mulholland Professor of Medicine and chair of the Department of Medicine; Sana Khan, MD, who completed her nephrology fellowship at UVA and joined the division as an assistant professor of medicine in 2014, was appointed associate director of the UVA Peritoneal Dialysis Program in FY 2015.

Transplantation

The kidney transplant program at UVA, started in 1967, is one of the busiest in Virginia; it has performed more than 1,800 transplants to date. Kidney transplant recipients come from all over Virginia, from other states and from other countries. Many such referrals involve high-risk recipients or otherwise extremely challenging cases that require state-of-the-art diagnostic and therapeutic approaches. The transplant program offers innovative translational research protocols, including transplantation for sensitized patients — those who are both ABO-incompatible and cross match-positive with their only available live donor — as well as donor advocacy and support for altruistic live donation.

The division is working to strengthen its kidney transplant service through enhanced outreach efforts in regions across the commonwealth. Its newly renovated outpatient clinic in the West Complex accommodates a higher volume of patient referrals, and the transplant nephrologist team expanded to consist of five full-time nephrologists. The program has a goal of at least 130 active patient listings per year, with a target of 5 percent growth each year.

In the first eight months of 2015, the division exceeded its numbers for 2014, and is poised to do approximately 100 kidney transplants in 2015. To expand opportunities for patients needing kidney transplantation, the program is striving to increase the number of living-donor transplantations with recruitment of a new living-donor coordinator and dedicated living-donor education for each recipient who is evaluated in the division’s transplant clinics. In FY 2014, there were 12 living-donor transplants; for FY 2015, the division projects there will be more than 20. Angie Nishio-Lucar, MD, assistant professor of medicine and co-director of the kidney living donation program within UVA Transplant Center, is leading the effort to increase participation in the living donor program. Dr. Nishio-Lucar completed her general nephrology fellowship and transplantation training at the University of Virginia.

In 2015, the UVA Health System Transplant Center received the 2015 National Kidney Registry Excellence in Teamwork Award for being part of the largest transplant chain in the U.S. UVA was one of 25 U.S. transplant centers honored for participating in a transplant chain, also known as a paired donor exchange, which enabled 35 patients to receive a kidney transplant.

The American Society of Transplantation Fellowship program at UVA is under the guidance of Gayle Vranic, MD, assistant professor of medicine and associate director of the Transplant Fellowship Program. Dr. Vranic came to the University of Virginia after completing training in internal medicine and nephrology at Vanderbilt University, and was the division’s first nephrology transplant fellow. After finishing her fellowship, she was recruited to join the faculty in November 2011.

During her training at UVA, supported by an National Institutes of Health T32 grant, she obtained an MS in clinical research; she now combines a thriving clinical practice with research on outcomes in kidney transplantation, with a particular focus on racial and socioeconomic barriers to transplant. Her clinical activities focus on the care of patients after kidney and pancreas transplant, evaluation and management of potential transplant recipients, care of chronic kidney disease after liver transplant and pregnancy after solid organ transplant. She is active in recruitment and teacher and mentor in the general nephrology transplant program as well as for programs in the School of Medicine and the School of Nursing and in Department of Medicine’s internal medicine residency program.

Transitional Extracorporeal Care Unit

UVA Division of Nephrology addressed an unmet need in the region when it opened the Transitional Extracorporeal Care Unit (TECU). The medical director of this facility is Emaad Abdel-Rahman, PhD, MS, MBBS, professor of medicine and section head of Geriatric Nephrology. The TECU provides outpatient dialysis for those patients who are discharged from the hospital and continue to require hemodialysis following acute kidney injury. Currently, Medicare does not reimburse end-stage renal disease (ESRD) facilities for providing dialysis in these patients. The TECU provides optimal outpatient management that gives the patient the best opportunity to recover renal function, thereby allowing discontinuation of dialysis treatments.

UVA opened its TECU to provide this service for those patients who would otherwise require in-patient dialysis. Since this service began, the TECU has provided dialysis for over 192 patients. Preliminary results indicate that 40.5 percent of patients recover renal function to be dialysis-independent. This compares with historical data in which 0.3 percent to 8 percent recovered renal function when dialyzed in ESRD facilities.

New Faculty Member Focused on Toxicology

Many medications and recreational drugs have adverse and life-threatening effects. The kidney safeguards us against toxicity to due to its ability to eliminate these drugs and medications. An important and often overlooked area of nephrology is toxicology. Joshua King, MD, assistant professor of medicine, is one of the division’s recent recruits, joining the faculty in September 2015. He received his residency training at UVA followed by a nephrology fellowship training at Johns Hopkins University. He then returned to UVA to pursue fellowship in medical toxicology. Dr. King will focus his research efforts in the area of toxicology and, in particular, he is interested in drug elimination through renal replacement therapy. He will maintain a general nephrology practice and focus his in patient clinical care in critical care nephrology.