Clinical

CLINICAL: Nephrology

As Nephrology’s reputation has grown over the last decade, so has its clinical practice and patient referrals, reflected in a 27% increase in revenue and 20% increase in wRVUs over the last six years. 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.

New clinical services launched in the last five years include:

• Chronic kidney disease clinic at Orange
• Kidney stone clinic at the Augusta Medical Center
• Dialysis and consultation services at UVA Health South Rehabilitation hospital
• Dialysis and consultation services at UVA Transitional Care Hospital
• Rapid Access Clinic located in the UVA Kidney Center, in which urgent referrals are seen within 24 to 48 hours
• Dialysis clinic in Alta Vista, and home hemodialysis programs including short daily hemodialysis, in both Charlottesville and Lynchburg
• Transitional Extracorporeal Care Unit (TECU) to care for patients requiring temporary dialysis for acute kidney injury, or that require apheresis on an outpatient basis

The division plans to add urgent-start peritoneal dialysis and ultrafiltration services in the near future.

During FY 2013, all eight UVA dialysis centers, which together served over 800 dialysis patients, achieved “Five Diamond” status from the Mid-Atlantic Renal Coalition (MARC). The MARC program consists of 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 five-diamond status. This is the third straight year that all of the UVA Health System’s dialysis clinics have garnered a top patient-safety honor from the MARC program. Only 21 dialysis centers in Virginia have five-diamond status.

Another patient safety-related effort, the Acute Kidney Injury (AKI) Risk Reduction initiative, initiated and managed by Dr. Charles H. Brooks, has decreased the risk-adjusted incidence of AKI, with significant cost savings and reduction in hospital length-of-stay.

Transplant program

The kidney transplant program at UVA, started in 1967, is currently one of the busiest in the state; it has performed more than 1800 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 crossmatch-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 state. Its newly renovated outpatient clinic in the West Complex will accommodate a higher volume of patient referrals, and the transplant nephrologists recently recruited to the faculty – Sundararaman Swaminathan, Gayle Vranic and Angie Nishio-Lucar – will further expand its clinical capacity. The goal for the program is at least 125 active patient listings per year, with a target of 5% growth each year after 2013. In FY 2013, the program exceeded its forecasted number of transplants. To offset the decreased availability of deceased-donor organs, the program is striving to increase the number of living-donor transplantations.