INTERVENTIONAL NEPHROLOGY IN NEPAL:ITS TIME IS COMING

Introduction:

Interventional Nephrology (IN) is rapidly gaining popularity as a new sub-specialty of Nephrology. In Nepal, senior nephrologists (Dr Rishi K. Kaflae, Dr Rajendra Agrawal) used to put arteriovenous shunts in dialysis patients. A few of the new breed of nephrologists are currently doing procedures like tunneled hemodialysis catheter (TDC) insertions, Tenckhoff catheter (TC) insertions, arteriovenous fistula (AVF) creations and point of care ultrasonography in nephrology (POCUN). Furthermore, a lot of young nephrologists are keen to learn the skills of IN. 

Methods:

We talked to the individual nephrologists who are currently doing IN procedures and asked to share their experience. We tried to get their publications to see their results. Besides, we also did an online survey among the nephrologists to assess their interest in IN. 

Results:

Nephrologist SS (first author of this manuscript) learned TDC insertions and AVF creation under the Asian Pacific Society of Nephrology fellowship in a center in India in 2015. Upon his return to a center in Eastern Nepal, SS started doing the above procedures independently and published his outcomes in Kathmandu University Medical Journal (Tabel1).1 SS invited an International Society of Nephrology (ISN) educational ambassador to his center in Eastern Nepal and learned TC insertions.2 SS has done around 300 AVF creations, and around 50 TC insertions and TDC insertions each.  Currently SS is shifted to Kathmandu and is continuing with the above procedures. Nephrologist NB (second author of this manuscript) underwent ISN fellowship on IN in a center in India in 2020, and is actively doing procedures like TDC insertions, POCUN, AVF creations, TC insertions in Kathmandu.  On personal communication, NB said that he has done about 80 TDC insertions, 40 TC insertions, 42 AVF creations, 8 AVF salvage procedures and about 28 endovascular procedures. He has incorporated POCUN in his usual nephrology practice and his centre has nephrologist led active vascular access evaluation program and vessel mapping is also done for all the AVFs created by him. 3 Nephrologist KS (third author of this manuscript) is actively promoting continuous ambulatory peritoneal dialysis in Nepal and on personal communication said that she has done about 450 TC insertions.

We sent an online survey to 56 nephrologists of Nepal. 35 of them responded. 34 (97%) responders said that they do native kidney biopsy, but only 24 (68.6%) do graft kidney biopsy. 31 (88.6%) do temporary hemodialysis catheter insertions, 12 (34.3%) do TDC insertions, 3 (8.6%) do AVF creations, 13 (37%) do TC insertions, 11 (31.4%) do POCUN and only 1 (0.35%) does endovascular interventions.  26 (75%), 29 (83%). 22 (62%), 21 (60.6%), 26 (74%) responded that they want to learn the skill of TDC insertions, graft kidney biopsy, AVF creation, endovascular interventions, TC insertions respectively. 25 (71.4%) responders said that they would undertake an IN fellowship, if given an opportunity. All 35 responders (100%) agreed that IN should be an integral part of nephrology curriculum.

Conclusions:

Some nephrologists in Nepal are doing IN procedures and a lot are interested. The future of IN in Nepal seems promising. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.