PGY4/5 Adult Nephrology Residency Training Program
Home Dialysis
Rotation-Specific Training Objectives
Overview
During this rotation, the trainee must demonstrate competence in managing patient
with end-stage renal disease. The trainee will be exposed to a wide variety of home
dialysis renal replacement therapies as well as the biology of the peritoneum and
principles and practice of peritoneal dialysis. The trainee will understand how home
hemodialysis, especially nocturnal hemodialysis, is distinct from in-centre
hemodialysis.
Areas of competence may include: Dialysis prescription (ie hemodialysis prescription,
modalities and longitudinal care; peritoneal dialysis prescription and longitudinal
care; home hemodialysis prescription and longitudinal care depending on specific
rotation); evaluation and management of complications of ESRD, including anemia,
renal bone and mineral disorders, calcium and phosphorus metabolism, cardiac
disease, hypertension, hyperlipidemia, and acquired cystic disease; assessment and
management of vascular access complications in fistulas, grafts and central lines;
assessment and management of peritoneal dialysis catheter complications including
exit site and tunnel infections and peritonitis; pharmacology of drugs in renal
disease; chronic disease prevention management; utilization of community care
resources; and nutrition. In the home dialysis rotation, pathology will also be
included in the rotation. Additional areas of competence will include recognition of
the compartments of the kidney, specific stains for disease, basic understanding of
the pathological diagnosis of kidney diseases.
At the end of this rotation, the trainee will be able to:
Medical Expert

Complete an accurate and well organized history and physical examination of
the patient with CKD/ESRD.

Formulate an accurate diagnosis and differential diagnosis, plan of
investigation and plan of treatment for the patient with CKD/ESRD.

Recognize emergency situations, and use appropriate management strategies
for dialysis emergencies: disequilibrium, hypotension, embolism, dialyzer
reactions.

Demonstrate adequate knowledge of the pathophysiology and complications
of CKD/ESRD.

Demonstrate adequate knowledge of the principles of hemodialysis, peritoneal
dialysis and apheresis.

Prescribe and modify hemodialysis, peritoneal dialysis and apheresis orders
appropriately.

Assess dialysis adequacy and formulate necessary changes in management.
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
Institute screening and preventative care as per guidelines for patients with
CKD/ESRD.

Prioritize patients’ acuity and corresponding management appropriately.
Communicator

Demonstrate skills in working with other providers and patients to overcome
communication challenges including anger, confusion, sensory or cognitive
impairment, socio-economic or ethno-cultural differences

Communicate effectively with patients and families

Establish a therapeutic relationship with patients and communicate well with
family.

Provide clear and thorough explanations of diagnosis, investigation and
management in a professional manner.

Demonstrate empathy and sensitivity to racial, gender and cultural issues.

Obtains informed consent, providing sufficient information regarding risks and
benefits of treatment alternatives

Written orders, progress notes and consult notes are well organized, timely
and legible.
Collaborator

Demonstrate knowledge of and respect for the individual team members’
contributions and roles in the care of patients with ESRD/CKD.

Communicate effectively with members of a multidisciplinary team.
Leader

Carry out appropriate clinical services in the context of limited resources,
limited expected lengths of stay, and limited time available for the resident.

Make cost effective use of health care resources based on sound judgement,
balancing resources to maximize benefits to all patients, including managing
provision of dialysis materials and equipment

Demonstrate time management skills to reflect and balance priorities for
patient care, sustainable practice, and personal life;
Health Advocate

Advocate effectively for the biopsychosocial needs of patients and their
families within the health care system and community

Support health of patients/families by encouraging the appropriate use of
home dialysis therapies and recognizes the impact on patients and their
families

Work with patients, families and community services to allow patients to
successfully initiate and continue home dialysis therapies
Scholar
 Develop a plan for self-improvement
 Maintain and enhance professional activities through ongoing learning.
 Critically evaluate medical information and its sources, and apply
appropriately to practice domains.
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
Educate other health professionals about renal related patient issues and
learns from allied health professionals regarding specific patient issues.
Professional
 Carry out duties in a professional manner
 Demonstrate professional behaviours including timeliness, honesty,
compassion and reliability.
Dialysis Curriculum
Please see Appendix A for a comprehensive rotation curriculum
Reviewed & approved by RPC
Date
Rev09.24.15
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