Credentialing for diagnostic and interventional nephrology

UNLABELLED: It is necessary to define the credentialing process that allows the nephrologist to achieve certification and accreditation in the following essential procedures of diagnostic and interventional nephrology: renal echography; renal and bone biopsies; the creation of vascular (arteriovenous fistula [FAV], grafts) or peritoneal access for permanent dialysis; the management and treatment of possible complications; and the implantation of central venous catheters for temporary or definitive hemodialysis. BACKGROUND: The acquisition of credentials for the interventional nephrologist includes the completion of training programs, the identification of appraisal indices, certification, possible recertification, and accreditation. The specialist validation allows the nephrologist to act as a tutor and supply the credentials for the interventional procedures in nephrology. The use of echography has remarkably simplified the procedure of percutaneous renal biopsy, a technical diagnostic invasive technique, practiced exclusively by the nephrologist the ecography-guided technique has reduced the risks of greater complications to less than 0.5%. However, guidelines are lacking on the training required to accredit a nephrologist in this technique. The initial placement of a shunt, vascular or peritoneal, to carry out dialysis treatment is usually performed by the nephrologist, radiologist, or surgeon. However, the successful long-term management of the dialysis patient generally demands a multidisciplinary approach. The poor management of the dialysis shunt can contribute to reduced patient life expectancy and increased costs of care. Therefore, it is essential that those who perform such interventional procedures must be certified and accredited according to strict protocol guidelines. In Italy (as opposed to the United States) most peritoneal shunt placements are performed by the nephrologist. However, international scientific society guidelines on this procedure, where they exist, are generic, allowing for the adaptation of particular techniques by various nephrologic centers. The criteria for the acquisition of credentials in one particular procedure must be uniform, logical, consistent, and applicable, comprising of a recognition of the basic procedure and a course of appropriate practical training. The criteria for training and credentialing in diagnostic and interventional nephrology should encompass the following points: The establishment of guidelines for the performance of all procedures that ensures suitable and effective treatment, including during emergencies, and considering the hospital context in which the procedures are performed. The recognition that scientific society guidelines for one specialty or procedure may not be appropriate or applicable to credentialing in another specialty or procedure. The ability of guidelines to adapt to improvements in technique and new technologies. The stipulations of insurance coverage and legal counselling must be taken into consideration whenever accreditation criteria are developed. CONCLUSIONS: An adequately certified and accredited background improves the quality of care, reduces costs and waiting list time, and reduces those complications that could increase the length of hospitalization.