Matthew A. Sparks

An abstract is unavailable. This article is available as a PDF only.

An abstract is unavailable. This article is available as a PDF only.

Background: The diversity in presentation and cause of hyponatremia leads to a wide array of treatment modalities which are selected based on severity, chronicity, volume status, and putative cause. Due to the variability in treatment selection, it is pertinent to identify the clinical impact of the various treatment modalities and rescue therapies to inform future care. Objective: To evaluate the association between treatment modality and length of stay for patients with severe hyponatremia Methods: This single-center, retrospective study included patients 18 years of age or older with glucose-corrected serum sodium levels of <125 mEq/L upon admission to the intensive care unit (ICU). The primary endpoint was ICU length of stay, and its association with treatment modality was assessed using multivariable Poisson regression with the following explanatory variables: 3% sodium chloride, 1.8% sodium chloride or isotonic fluids, diuretics, proactive therapy, rescue therapy, nephrology consultation, baseline volume status, and pretreatment sodium level. Results: Eighty-two patients were included with a median age of 65 years old (Q1, Q3: 57, 72). The median glucose-corrected serum sodium was 116.3 mEq/L (Q1, Q3: 112.9, 120.5) and the median ICU length of stay was 3 days (Q1, Q3: 2, 4). Multivariable analysis, adjusting for baseline serum sodium levels, revealed the use of proactive and early reactive therapy (incidence rate ratio [IRR] 1.38, 95% confidence interval [CI] 1.11-1.71) and nephrology consultation (IRR 1.22, 95% CI 1.01-1.46) were associated with increased length of ICU stay. Conclusions and Relevance: Nephrology consultation and the use of proactive therapies were associated with increased ICU length of stay. Accurate identification of patients at high risk for osmotic demyelination syndrome that may benefit from proactive therapies is imperative, as use of proactive therapies in low-risk patients may prolong length of stay.

Key Points: Hands-on training is crucial for vascular access training. A multidisciplinary approach to vascular access training is paramount. Creation of a multifaceted vascular access curriculum is needed in all training programs. Background: This study seeks to provide insights into the current state of vascular access education in adult nephrology fellowship programs in the United States and to identify areas for improvement. Methods: A total of 63 adult nephrology programs and 71 second-year adult nephrology fellows were randomly selected for participation in a roundtable. Virtual roundtable discussions preceded by a survey were conducted to gather information on the delivery of vascular access education. Descriptive statistics were used for analysis. Results: Among the respondents invited to the roundtable discussions, 42 individuals (30 faculty and 12 fellows) completed the survey, while 21 individuals (13 faculty and eight fellows) also participated in the roundtable discussion. Of these respondents, most (67%) didactic lectures on vascular access in fellowship programs were delivered by general nephrologists, with 57% provided by interventional nephrologists, 36% by surgeons, and 17% by interventional radiologists (respondents were able to select multiple disciplines). The respondents reported limited exposure to proceduralists, including interventional nephrologists and vascular access surgeons during fellowship training. Faculty and fellows were less comfortable with physical examination skills related to vascular access, particularly in using point-of-care ultrasound and interpreting vascular imaging as compared with naming and identification of vascular access. Both groups emphasized the importance of hands-on modalities in vascular access education. Conclusion: Roundtable discussions highlighted the need for enhanced hands-on training, multidisciplinary collaboration, and standardized curricula in vascular access education. Recommendations were formulated in alignment with the three levels of competency outlined by the American Society of Nephrology Task Force on the Future of Nephrology, aiming to address gaps and improve the quality of vascular access education in nephrology fellowship programs. This study underscores the importance and need for a comprehensive vascular access education in nephrology fellowship training. By implementing the identified recommendations, programs can better prepare fellows to manage vascular access-related challenges in clinical practice.