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Opinion: What is the Current and Future Status of Interventional Nephrology?

adequacy. The initial, relatively small generation of interventional nephrologists made proportionately large contributions to technical improvements in endovascular approaches to optimizing vascular access function. Interventional nephrology is now a growing phenomena that is beginning to demonstrate maturity as a field. Evidence to support this contention includes the development of a societal home for interventional nephrologists, the American Society of Diagnostic and Interventional Nephrology (ASDIN). The publication of suggested credentialing criteria by the ASDIN is also a step toward ensuring quality (17). Interventional nephrology training programs are being established within the context of traditional nephrology fellowships, thereby increasing potential training opportunities for academic pursuits by interventional nephrologists. Perhaps of most importance, data are now being published by interventional nephrologists documenting excellent outcomes of vascular access intervention performed by interventional nephrologists (18,19). The development of interventional nephrology remains a work in progress. Unfortunately there likely will continue to be “turf battles” associated with the establishment of interventional nephrology clinical and training programs in many institutions (20). Nonetheless, it would appear that the concept of interventional nephrology is gaining acceptability in many institutions (21). Over time, academic interventional nephrology training is also likely to grow. We view this development as an opportunity, because formidable challenges remain in optimizing the outcomes of vascular access for hemodialysis patients in the United States. Data from the Dialysis Outcomes Practice Pattern Study (DOPPS) and other sources continue to demonstrate suboptimal patterns of vascular access use in the United States, as well as considerable facility and regional variations in vascular access practice patterns. The extent of variability suggests considerable room for process improvement. Further, given the limitations of currently available options, there is a substantial research agenda in the next decade for dialysis vascular access. These include a need for a better understanding of the potential role of vascular access monitoring in improving outcomes, defining optimal approaches to increasing functional arteriovenous fistula prevalence without concomitantly increasing tunneled catheter dependency, finding optimized approaches to minimizing infectious, thrombotic, and other complications from access use, and defining how pharmacologic therapy can help prolong useful vascular access function. Interventional nephrologists, working in collaboration and partnership as part of a multidisciplinary team, can contribute to these developments moving forward.