The Need to Emphasize Nephrology Knowledge in Residents-in-Training

Area of Science:

• Nephrology
• Internal Medicine
• Medical Education

Background:

• Chronic kidney disease (CKD) is a growing health concern with potential progression to end-stage renal disease.
• Hospitalized critically ill patients face risks of acute kidney injury (AKI) due to factors like poor renal perfusion, hypotension, nephrotoxins, and contrast media.

Purpose of the Study:

• To assess resident physicians' knowledge of CKD management.
• To evaluate awareness of timely nephrology referrals and prevention of AKI.
• To determine understanding of basic electrolyte physiology and drug management in renal insufficiency.

Main Methods:

• A cross-sectional online questionnaire survey was administered to internal medicine, Medicine/Pediatrics, and Family Medicine residents in the United States.
• The survey aimed to gauge resident knowledge regarding nephrology principles and patient care.

Main Results:

• Only 17% of surveyed residents completed the questionnaire (47 out of 270).
• A majority (57%) referred patients with estimated glomerular filtration rate <30 mL/min/1.73 m(2) to nephrology.
• Significant knowledge gaps were observed regarding medication safety (e.g., aspirin in stage IV CKD, metformin/Lovenox use) and management of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers around contrast exposure.

Conclusions:

• Residency training provides a critical window for establishing foundational nephrology knowledge.
• Key areas in nephrology require greater emphasis during residency to enhance patient care and mitigate AKI rates.