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An Introduction to dialysis education: Issues, innovations and impact

End-stage renal disease (ESRD) represents a significant public health burden in the United States with more than 678 000 prevalent cases by the end of 2014. This represents an astonishing 54% increase since 2000. Currently an estimated 2 million patients have ESRD worldwide. This high burden of ESRD patients is driven in large part by an increasing prevalence of diabetes mellitus, hypertension, and obesity. Because access to kidney transplantation is limited, the vast majority of these patients are treated with dialysis. In-center hemodialysis (HD) remains the leading therapeutic dialysis modality for this population in most countries, including the United States. As of 2014, among all incident ESRD patients in the United States, 87.9% initiated HD, 9.3% initiated peritoneal dialysis (PD), and only 2.6% received a preemptive kidney transplant. Recent literature has shown no significant difference in survival between dialysis modalities, specifically between in-center HD and PD; but there may be some differences in quality of life and satisfaction with care possibly favoring home dialysis modalities. Furthermore, the cost of care for patients with ESRD remains very high in the United States as <1% of the Medicare population continue to consume more than 7% of the Medicare budget with a staggering cost of $32.8 billion in 2014. As examples, in-center HD cost was $87 638 per person per year while this cost was less, at $73 612 for PD. Despite some potential clinical advantages and a lower cost of care, home dialysis modalities remain underutilized in most countries, including the United States. However, there are some exceptions such as Hong Kong with 72%, Jalisco region in Mexico with 47%, and New Zealand with 31% of ESRD patients treated on PD. This low utilization of home dialysis modalities may be due in part to a lack of training of our residents and fellows in these specific modalities but may also be due to a lack of timely education of patients with ESRD in selecting the most appropriate dialysis modality of their choice in a shared decision-making process. Similarly over the past several years, nephrology educators have observed deficiencies in the quality of training of fellows regarding acute renal replacement therapy, dialysis access procedures, and medical safety in the care of patients with ESRD but also importantly addressing issues related to the role of dialysis near the end of life. Emerging technologies include bedside diagnostic tools such as point-of-care ultrasound (POCUS) to help clinical decision-making. In addition, the role of telehealth in predialysis education will hopefully improve on comprehensive and timely ESRD initiation and modality selection, including conservative care. Many of our renal fellows are also ill-prepared to handle the business aspect of dialysis as well as their potential role as medical directors of dialysis units. Recognizing the significant role of the well-trained nephrologist in the quality of dialysis treatment delivery to provide the best possible patient care and outcomes, this issue of Seminars in Dialysis is dedicated essentially to provide an overview on all aspects of dialysis education. In their manuscript, Moist and Lindsay address gaps in nephrology education in general but also more specifically in hemodialysis training. They comprehensively review currently available hemodialysis curriculum including innovations in dialysis vascular access education and communication skills between physicians and ESRD patients. They conclude by addressing knowledge needed in quality improvement programs and quality-based metrics to properly supervise a dialysis program. Similarly in his manuscript, Mehrotra systematically addresses challenges and innovations in PD education. He argues for the need to ensure clinical competency of our nephrology trainees in PD and describe key elements needed to achieve this goal. He explains details in approaches and solutions for achieving clinical competency in PD such as having cared for a sufficient number of patients on PD, having faculty with appropriate clinical expertise in PD to supervise the trainees’ work, and including didactic PD instruction. For Home HD, Glickman and Seshasai describe the curriculum implemented in their program. As expected, clinical exposure is mandatory and the training is overseen by expert faculty members in the home HD modality. In addition, the authors describe their didactic approach with a special 2-day seminar covering both Home HD and PD. As in many academic training programs, as part of their curriculum, nephrology fellows need to be exposed to research opportunities and quality improvement projects. There is clearly a pressing need for nutrition education in our chronic kidney disease (CKD) and dialysis populations. In their manuscript, Anderson and Nguyen skillfully outline important nutrition education resources available to providers such as the National Kidney Foundation’s, Kidney Disease Outcome Quality Initiative (K/DOQI) and the National Kidney Disease Education Program (NKDEP). Furthermore, the authors review key dietary components and discuss practical issues in educational efforts specifically related to nutrition in patients with CKD or on dialysis. A very important component of the training of nephrology fellows includes an in-depth knowledge of the benefits and limitations of each dialysis modality. The well-trained nephrologist should then DOI: 10.1111/sdi.12680