Division of Nephrology Fellowship Training Program Overview


                      Division of Nephrology-- 2008
The Nephrology Training Program at Duke
 
Provides comprehensive training in clinical nephrology, dialysis, transplantation, hypertension, clinical and basic science research. 
 
Founded in 1962, the Fellowship Training Program has trained over 110 fellows, including seven section chiefs. The current division chief, Thomas M. Coffman, MD, has led the division since 1997.  Stephen R. Smith, MD, is the fellowship program director.
 
The Clinical Facilities Include
 
The Nephrology Fellowship at Duke

The Nephrology Fellowship Program at Duke is a fully accredited program that awards four new fellowships each year.  
 
The program provides training that is structured to meet the goals of each individual trainee.  Most fellows will complete one year of clinical nephrology followed by at least two years of intensive training in clinical or basic science research.  
 
The first year of research is part of the Accreditation Council for Graduate Medical Education (ACGME) nephrology fellowship. The second year of research is served as a Biomedical Scholar, an Institutional Council for Graduate Medical Education (ICGME) fellowship.
 
First-year clinical fellows take home-call once every six nights.  Second- and third-year research fellows are not in the weekly call schedule, but cover clinical fellows during vacation and time off.
 
A two-year clinical fellowship is also available.  
 
Among fellows who have completed their nephrology training at Duke in the past 10 years 50 percent have moved into academic positions, 44 percent have entered private practice, and 6 percent are currently working in research and industry

Clinical Inpatient Rotations
 
David Butterly, MD, Jane Schell, MD, Sejan Patel, MD in the Duke dialysis unit, 2008              David Butterly, MD with Jane Schell, MD on Dialysis Rounds, 2008
 
The clinical inpatient rotations consist of four services. The clinical year is divided equally among these services.
 
  • Acute Nephrology Service -- Interventional and consultative support (including CVVHDF) for patients in the intensive care units (MICU, CVICU, Neurosciences ICU) and general internal medicine wards at Duke University Hospital.   
  • 7800A Service -- Consultative care for patients admitted to the Duke Surgery Services (including the Surgical Intensive Care Unit) and kidney transplant service throughout the medical center.  The fellow will be directly involved in the care of patients on the inpatient service, a significant number of whom will be transplant recipients.  Exposure to the outpatient management of transplant patients is provided by attending the weekly Transplant Clinic.
  • Maintenance  Hemodialysis Service -- Consultative care for patients already on maintenance hemodialysis admitted to Duke University Hospital.
  • Durham VA Medical Center Service -- Consultative care for a mixture of fluid and electrolyte problems, acute and chronic dialysis, transplantation and general nephrology.

 


Outpatient Experience
Throughout their fellowship, all fellows maintain a half-day continuity clinic.  Each fellow will rotate through outpatient rotations during the clinical year, through which they will be exposed to: 
 
  • Transplant donor and recipient surgery
  • Permanent vascular access creation and maintenance
  • Plasmapheresis
  • Outpatient management of transplant patients
  • Difficult-to-manage hypertension
  • CKD clinic
  • Duke Lupus Clinic
 
Each fellow also participates in an outpatient dialysis rotation during the second year of training and attends a monthly peritoneal dialysis clinic.

The Second and Third Years of Training
The second and third years of the fellowship include intensive research training under the direction of a faculty mentor, funded by an NIH training grant.   Past fellows have been successful in securing additionally funds from other agencies, including:
We will also consider applicants who wish to complete their fellowship in two years, with additional time on the clinical services during the second year.

Clinical Investigator Pathway
Those fellows who choose the Clinical Investigator Pathway receive advanced training in biostatistics, study design, and epidemiology, and have the opportunity to pursue a Masters of Health Sciences Degree.   Some of the active areas of NIH and industry-funded clinical research in the division include:  
 
 
  • Epidemiology and outcomes in end-stage renal disease patients
  • Effects of dialysis dose on morbidity and mortality in dialysis patients
  • Improving vascular access for hemodialysis patients
  • Influence of patterns of care on outcomes of patients with chronic renal insufficiency
  • Cardiovascular disease in patients with renal failure
  • Epidemiology of HIV-associated nephropathy
  • Strategies for optimal management of hypertension in hemodialysis patients
  • Studies of dietary and non-pharmacological treatment of hypertension
  • Mechanisms of salt-sensitivity in African Americans
  • Optimizing immunosuppressive regimens in renal transplant recipients

Basic Science Investigator Pathway 
 
Medical Sciences Research Building 2 (MSRB2), where a majority of the Nephrology research labs are located-- 2008
 
Fellows on the Basic Science Investigator Pathway will choose a laboratory and mentor during their first year, after consultation with the division chief.  
 
The mentor will generally be one of the basic science faculty members from the Nephrology Division, but with the approval of the division chief, trainees may also choose to work in a laboratory outside of the division. This flexibility allows for trainees to take optimal advantage of the outstanding scientific environment at Duke.
     
Steven Crowley, MD teaching in the Nephrology Research lab,-- 2008                 Jason Eckel, MD --2008
 
Some of the funded ongoing basic science research in the division include:
 
 
  • Mandel Center for Hypertension and Atherosclerosis at Duke
  • The molecular biology of G-protein coupled receptor signaling
  • The immunobiology of transplant rejection 
  • Inflammatory responses in the kidney and their contribution to disease pathogenesis
  • The functions of the renin-angiotensin system in regulation of blood pressure and kidney function.
  • Pathogenesis of familial focal segmental glomerulosclerosis
  • Pathogenesis of autoimmune kidney diseases

For further information about this training program, please select one of the quick links to the right.
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