SUNY Downstate Health Sciences University
Division of Renal Disease
Center for Dialysis at Parkside
Welcome to our world class kidney transplant oriented Dialysis Center for adults and children.
Patients with renal disease including acute and chronic renal failure, diabetic nephropathy and inherited kidney disease are treated in a warm, safe and comfortable, home-like environment.
Our Center for Dialysis at Parkside supports all University Hospital of Brooklyn outpatient and home dialysis programs for adult and pediatric renal programs; acute and chronic hemodialysis, acute and chronic peritoneal dialysis, continuous ambulatory peritoneal dialysis and home dialysis and where appropriate ambulatory femoral dialysis.
The ambulatory rotation is a component of the home hemodialysis Dialysis and peritoneal dialysis rotation detailed in the next section. The fellow can attend the home dialysis clinic located at Parkside HD unit on Thursday afternoons. This rotation allows the fellow to mastering skills in home dialysis management.
CAPD/CCPD: The second-year fellow will attend the home dialysis clinic and peritoneal dialysis clinic at Mt. Sinai hospital for 1 month. Fellows can also attend downstate, outpatient home hemodialysis which occurs on Thursdays at 1:00 PM. The clinic is run by Dr. Saggi, in conjunction with a nurse and physician assistant. Every patient is discussed in detail. The fellow may be called to see a patient with an acute problem relating to CAPD at Parkside Dialysis Center. In this circumstance, the fellow will respond, examine the patient and discuss with Dr. Saggi or covering attending. If a patient is referred to the ED, then fellow will respond. The fellow should be in contact with the home dialysis nurse on a daily basis to see if any problem exists. If there is a patient in training, the fellow is expected to spend adequate time with the training nurse to learn all applicable techniques.
Specific learning objectives in this rotation include learning CAPD technique and prescription, adequacy of CAPD, PET test and fluid and peritonitis management. In addition, the fellow is required to identify and manage anemia, bone disease, nutrition, catheter related problems, cardiovascular surveillance and management of co-morbid conditions. The fellow is encouraged to read these topics ahead of time. As part of the rotation, the fellow will be asked to prepare a twenty-minute presentation on a peritoneal topic of his/her choice for the other fellows. Dr. Saggi will assist in the preparation. The more time spent in the home clinic, the more the learning process.
Home HD: Home hemodialysis patients attend the Thursday clinic as well. Specific learning objectives when reviewing home hemodialysis patients include learning home HD technique and prescription, adequacy of HD, anemia, bone disease vascular access, nutrition and cardiovascular and co-morbid disease management. The fellow is encouraged to read these topics ahead of time. Fellows will get more in-depth training on home HD and peritoneal dialysis at Mt. Sinai hospital.
Second year fellows to rotate through the Home Dialysis Program at Mount Sinai School of Medicine/Mount Sinai Hospital for their training in home dialysis, which includes Home Peritoneal Dialysis as well as Home Hemodialysis. Downstate fellows will be trained in learning how to screen appropriate candidates for Home Dialysis, learn different types of procedures needed to accomplish access to either peritoneal membrane for Home Peritoneal Dialysis or vascular access appropriate for home hemodialysis therapies. Fellows will be trained with Dr. Jaime Uribarri, Home Dialysis Director. Fellows will also spend time in their outpatient Interventional facility to see PD catheters being placed under fluoroscopy, as well as observe in the Operating Room laparoscopic placement of PD catheters. Fellows will learn how to manage catheter post operatively, how to start low volume peritoneal dialysis immediate post op if needed.
Specific Goals & objectives
For 1st year fellows
- Learn how to write chronic hemodialysis prescriptions
- Learn how to write chronic peritoneal dialysis prescriptions
- Learn anemia management, nutrition
- Learn management of bone disease
- Monitor vascular access function
- Learn basic general medical care of the chronic dialysis patient
- Learn communication with the inpatient teams when a chronic dialysis patient is sent to the emergency department
The fellow is expected to make decisions and then discuss those decisions with the attending before implementing the plan.
For 2nd Year fellows
- In addition to skills learned in the first year:
- Learn to write dialysis prescriptions (hemo- and peritoneal) without the assistance of the attending
- Learn to manage all the general medical care of the chronic dialysis patient
- Learn the physical functioning of the dialysis unit including water treatment, filter reuse, and business practices
At a minimum, the attending is physically present at rounds once a week. If the attending was not physically present, the fellow contacts the attending to discuss each shift. Initially, all patients are discussed. Later in the year, only patients with active issues are discussed; stable patients are not specifically discussed.
Core competencies to be evaluated include:
- Obtain comprehensive history and physical examination pertinent to the evaluation of the kidney on CAPD, home hemodialysis and electrolyte physiology
- Accurately assess a patient for the differential diagnosis of electrolyte, acid base and volume disorders, CAPD and home hemodialysis
- Demonstrate the ability to recognize and manage common electrolyte, acid base and volume disorders, CAPD and home hemodialysis
- Demonstrate the ability to recognize and manage various medical complications of common electrolyte, acid base and volume disorders, CAPD and home hemodialysis
Demonstrate knowledge appropriate for a general nephrologist of the following:
- Electrolyte, acid-base and mineral disorders
- Hypo and hypervolemia
- Normal and high anion gap metabolic acidosis
- HD and CAPD technique and prescription
- Adequacy of PD, PET testing
- Peritonitis management
- HD technique and prescription
- Adequacy of HD
- Anemia, bone disease vascular access, nutrition, cardiovascular and co-morbid disease management
- Demonstrate ability to use information technology to answer questions in this rotation and ability to analyze the quality of evidence supporting interventions
- Identify patient safety issues in the dialysis unit and understand procedures in place/propose new procedures to minimize errors
- Demonstrate understanding of reimbursement for CAPD and home hemodialysis
- Understand the roles of members of the health care team treating CAPD and home hemodialysis patients– nurse, nephrologist, dietician, social worker, transplant coordinator, podiatrist, diabetes educator, vascular surgeon, etc. and work effectively with other team members
Interpersonal and communication skills
- Demonstrate ability to write a coherent and useful consultation note
- Demonstrate empathy for patients on CAPD and home hemodialysis
- Clearly and appropriately explain diagnostic thinking and management options/plans to patients and families;
- Consistently demonstrate respect for patients, staff, and colleagues
- Demonstrate understanding of the issues surrounding informed consent for procedures in CAPD and home hemodialysis
- Demonstrate understanding of major ethical issues in this rotation
- Subodh Saagi, MD, MPH, Director
- Clinton Brown, MD
- Errol Carter, MPA Administrator
- Mary Mallappalil, MD
- Ernie Yap MD
- Arye Kremer MD
- SUNY Downstate Chronic Dialysis Hotline: (718) 703-5900 or 5920
- State of the art design used at the Center lends itself to team care concept; all patients can be seen from a centralized nursing station.
- 20 adult treatment stations
- 4 pediatric treatment stations in a children's area
- 4 home dialysis training stations and individual training rooms to increase home care opportunities for patients
- Personal touches for patients such as cushioned lounge chairs equipped with TV units
- Conference room equipped with a sophisticated audio-visual system
- Most private insurance and managed care plans, union plans, Child Health Plus, Medicaid managed care plans, Medicaid and Medicare are welcome
- We intend to make the necessity for dialysis as comfortable as possible while maximizing each patient's quality of life