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Survey of Kidney Biopsy Clinical Practice and Training in the United States.

ABSTRACT: BACKGROUND AND OBJECTIVES:Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:An anonymous, on-line survey of all Walter Reed training program graduates (n=82; 1985-2017) and all United States nephrology program directors (n=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. RESULTS:Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers (P=0.02), or whose fellows performed ≥50 biopsies (P<0.01). CONCLUSIONS:Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.

SUBMITTER: Yuan CM

PROVIDER: S-EPMC5968891 | biostudies-other | 2018 May

REPOSITORIES: biostudies-other

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Survey of Kidney Biopsy Clinical Practice and Training in the United States.

Yuan Christina M CM Nee Robert R Little Dustin J DJ Narayan Rajeev R Childs John M JM Prince Lisa K LK Raghavan Rajeev R Oliver James D JD

Clinical journal of the American Society of Nephrology : CJASN 20180418 5

<h4>Background and objectives</h4>Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial.<h4>Design, setting, participants, & measurements</h4>An anonymous, on-line survey of all Walter Reed training program graduates (<i>n</i>=82; 1985-2017) and all United States nephrology program directors (<i>n</i>=149; August to October of 2017), regarding kidney biopsy practice and training ...[more]

PMID: 29669819

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Survey of Kidney Biopsy Clinical Practice and Training in the United States.

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Survey of Kidney Biopsy Clinical Practice and Training in the United States.

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