Fellowship Training Program

The Department of Nephrology and Hypertension provides comprehensive diagnostic and therapeutic service for patients with renal disease and hypertension. The Department participates in an active renal transplant program, all modalities of dialysis care, and clinical research studies of diabetic and other glomerular disease. In addition to unique diagnostic capabilities, the Department offers specialty clinics in renal stone disease, renal transplantation, chronic renal diseases and hypertension.

A two-year Nephrology-hypertension fellowship is offered within the department with three fellows at each level. The fellowship program is open to those who have completed a three-year internal medicine residency.

In addition, a new one-year advanced program in Nephrology-critical care medicine was instituted within the department in 1993, for which one position* is available each year. Candidates must first complete the two-year Cleveland Clinic Nephrology fellowship.

Nephrology-Critical Care Medicine

The Department of Nephrology and Hypertension has a one-year training program which prepares candidates for board eligibility in Nephrology with added certification in critical care medicine.

The Nephrology/critical care medicine fellow is selected from among the three fellows accepted into the Cleveland Clinic’s Nephrology fellowship program each year.Recognized nationally and internationally for its expertise and contributions in the Intensive Care Unit (ICU) setting, the department has instituted the critical care medicine fellowship tract in response to the increasing involvement of Nephrology in critical care medicine.

This program allows the fellow to broaden his/her experience in areas such as acute care medicine, acid-base physiology and fluid-electrolyte problems, and to examine the potential applications of dialytic therapies in non-renal indications such as intoxications, ARDS, multiple organ systems failures and more.

The training in Nephrology-critical care medicine offers extensive multidisciplinary experience, including rotations in medical, surgical, cardiovascular and coronary intensive care units. In these ICU areas, the fellow is directly responsible for patient care and the performance of procedures. Training is also provided in outpatient surgery, burn/trauma care, pharmacology service and bioethics. In addition, several months are devoted to clinical or basic research.

Fellow Rotations

During the first and second year, fellows participate in their weekly long-term care outpatient clinic as well as specialty clinics such as the renal stone, CAPD and renal transplant clinics.

Year One

• 12 months of clinical experience
• 4 months renal transplant
• 4 months consultative Nephrology
• 2 months chronic dialysis
• 2 months ICU Nephrology

Year Two

• 3 months consultative Nephrology
• 1 month ICU Nephrology
• 8 months research elective (clinical or basic)

On-call Schedule

Fellows are on-call from home; there is no hospital on-call. First-year fellows are on-call an average of seven days per month, including one weekend with responsibility for hospital rounds. Second-year fellows are on-call approximately five nights per month, including one weekend on-call with rounds.

Teaching Conferences

In addition to these formal teaching programs, fellows participate in daily patient care and teaching rounds with attending staff Nephrologists.

Benefits

Salary is commensurate with PGL-4/5 training. Critical care medicine fellows receive PGL-6 compensation. All fellows receive three weeks of vacation per year. Allowances are available for travel privileges, and other educational activities. For details on other benefits, including health care and insurance, contact the Cleveland Clinic’s Graduate Medical Education office at 216/444-5690.

Scope of Nephrology and Hypertension Services

The Cleveland Clinic Foundation’s Department of Nephrology and Hypertension has fourteen Nephrologists. The department provides a wide range of services in clinical Nephrology and hypertension, intensive care Nephrology, chronic dialysis and renal transplantation.

Clinical Nephrology and Hypertension

A very active Nephrology and hypertension clinical practice includes outpatient as well as inpatient services. Fellows gain wide knowledge in clinical diagnostic studies and therapeutic procedures, including the clinical application of peritoneal and hemodialysis. The Department participates in various clinical research trials, such as the Diabetic Nephropathy/ACE Inhibitor Trial, the Modified Diet in Renal Disease (MDRD) Trial. The Department of Biostatistics at the Cleveland Clinic is a leading component of major clinical trials in Nephrology funded by the National Institutes of Health (NIH).

For decades, the Cleveland Clinic has been recognized as a national and international resource for hypertension research and patient care. The Department is renowned for its expertise in the areas of renovascular hypertension, primary aldosteronism and pheochromocytoma.

Hypertension secondary to renal artery disease has been the interest of department members along with others in the Department of Urology, the Research Institute, and the Division of Radiology.

The department has established a Renal Stone Clinic in conjunction with the Department of Urology. This clinic is responsible for diagnosing and managing patients with complicated metabolic stone disease. Extracorporeal shock ware lithotripsy is performed on more than 500 patients each year while percutaneous tract lithotripsy continues to be performed on patients with large and otherwise complicated stones.

Intensive Care Nephrology Services

The Department of Nephrology and Hypertension is a major participant in the intensive care setting via care to ICU patients with acute renal failure, volume disturbance, fluid/electrolyte and acid/base disorders. Cleveland Clinic Nephrologists have lead in the development of several techniques for treatment of acute renal failure such as slow continuous ultrafiltration, continuous arteriovenous hemofiltration and venovenous hemofiltration. Direct exposure to intensive care Nephrology through more than 300 consults per year across nine intensive care settings throughout the Cleveland Clinic Hospital provides fellows with experience in acute Nephrology that is unparalleled. Much of the experience is related to the remarkably active cardiac surgery services that characterize Cleveland Clinic.

Chronic Dialysis Services

Approximately 50,000 hemodialyses and more than 1,000 peritoneal dialyses are performed annually in several dialysis units operated by the Cleveland Clinic. In addition, a home dialysis program was instituted in 1964.

Hemodialysis (HD)

Fellows are exposed to all the various forms of Extracorporeal therapy currently in practice, as well as those under development. Experience with patients who require HD support is obtained through patient assignments in one of the three Cleveland Clinic outpatient HD units. Emphasis is placed on dialysis prescription, access viability and long-term uremic effects on multi-organs. In addition, fellows receive in-depth training in dialysis membrane physiology, HD consequences of therapy and technical aspects such as water treatment and principles of membrane reuse.

Peritoneal Dialysis (PD)

The Cleveland Clinic has been a pioneer in clinical research and in the development of techniques for PD. Fellows are exposed to the techniques of both continuous ambulatory PD and automated PD in a population of more than 100 patients. Fellows will be actively involved in the PD outpatient clinics as well as in the training of patient entering the program.

Each fellow is assigned to work with one primary nurse and to follow a specific patient population. Acute problems that arise, as well as the chronic surveillance of the dialysis prescription and metabolic complications, are addressed by the fellow under the supervision of the staff physician. Weekly chart rounds are conducted on Clinic patients, and problems that may arise with patients in the hospital or those at home on chronic dialysis are discussed. In addition, a series of didactic talks is conducted, which are aimed at increasing the fellow’s understanding of peritoneal dialysis and the approach to problem solving.

Following completion of the training program, the fellow will have both the experience and knowledge to initiate and follow PD patients with end-stage renal disease.

Renal Transplantation

The department actively participates in the Cleveland Clinic’s Transplantation Center, which coordinates kidney, kidney-pancreas, cardiac, bone marrow and liver transplants. The Cleveland Clinic’s kidney transplant program dates to January 1963. Since then, more than 2100 kidney transplants have been performed here. Each year, between 75 and 100 kidney transplants are performed at the Clinic and about 10 kidney-pancreas transplants. Fellows assist staff in the pre- and postoperative medical care of transplant candidates, as well as their long-term follow-up care. The Clinic participates in a nationwide tissue typing and organ recovery program and also serves as the tissue typing resource for the Northeast Ohio region, offering state-of-the-art technologies such as DNA typing and flow cytometry.

Research

The Department is actively involved in clinical and basic research. Its legacy of excellence in hypertension research began at the CCF in 1945. For more than 30 years, the Clinic has received support from the NIH for its research into the causes of hypertension.

More than 25 research projects on kidney diseases are funded here annually, and the Clinic was one of only six medical centers around the country to be named an NIH Specialized Center of Research (SCOR) in hypertension.

The department is currently involved in the Diabetic Nephropathy Trial, the Morbidity and Mortality in Dialysis Trial, the African-American Study of Kidney Disease and other local and national research programs.

Fellows have the opportunity to conduct basic research through CCF’s combined Nephro-urologic Research Laboratory. The investigative activities in this laboratory are in the areas of renal physiology, renin-mediated hypertension and ischemic Nephropathy. This lab has special expertise in renal preservation for transplantation, acute renal failure, and hypertension in the kidney.

Opportunities also exist for collaborative investigation with other basic laboratories within the departments of Immunology, Thrombosis and Vascular Biology and Cardiovascular Biology.

More Information

For more information about the Nephrology and Hypertension Fellowship Program or for an application, contact:

Richard Fatica, M.D.
Cleveland Clinic Foundation
Department of Nephrology and Hypertension
Desk A-51
9500 Euclid Avenue
Cleveland, OH 44195

Phone: 216.445.9953
Fax: 216.444.9378
E-mail: faticar@ccf.org