Level 2: Transition course in Intensive Care Nephrology

Pathway directors

• Bairbre MCNICHOLAS MD PhD Consultant Intensivist and Nephrologist at Galway University Hospitals; Senior lecturer, University of Galway, Galway, Ireland
• John PROWLE MD, FRCP, FFICM Senior Clinical Lecturer in ICM, Queen Mary University of London, Consultant in Renal and Intensive Care Medicine, Royal London Hospital, London, United Kingdom

Directors Level 2

• Yvelynne KELLY MD, Consultant Intensivist, Department of Critical Care, Tallaght University Hospital, Dublin, Ireland
• Melanie MEERSCH MD, Prof. Senior Physician and Head of Post ICU Care, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany
• John PROWLE MD, FRCP, FFICM Senior Clinical Lecturer in ICM, Queen Mary University of London, Consultant in Renal and Intensive Care Medicine, Royal London Hospital, London, United Kingdom
• Ahmet Oğuzhan KÜÇÜK MD Consultant Intensivist, Karadeniz Technical University, Farabi Hospital, Trabzon, Turkey
• Thomas RIMMELÉ MD, PhD Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France

Outcome 1: Epidemiology/Risk of AKI

Evaluate Risk of AKI in patient populations based on epidemiological research

Analyse risk factors for Acute kidney injury and how the differ in specific clinical context

Apply understanding between modifiable and non-modifiable risk factors to clinical interventions

Apply knowledge of AKI risk to focused clinical examination in AKI

Outcome 3: Describe pathophysiology of AKI
Analyse typical aetiologies of AKI and how these alters in differing AKI settings

Outcome 4: Diagnosis of AKI
Evaluate staging system currently used to diagnose AKI including their strengths and weaknesses

Evaluate the role of in urine and creatinine in defining and staging AKI

Analyse the limitation of creatinine for diagnosis of AKI

Outcome 7A: CRRT/RRT- Component and mode
Apply understanding of the extracorporeal circuit to Identify key components of a CRRT machine and their role.

Apply understanding of key modes of CRRT to analyse their potential specific benefits

Compare and contrast mechanism of Solute and Fluid Removal during different RRT modalities

Apply understanding of key terms: convection, diffusion, ultrafiltration to analysis of RRT modalities

Analyse the mechanisms of fluid movement across a semipermeable membrane and the factors determining flux

Evaluate benefits and risks of anticoagulation options for CRRT.

Apply understanding of the RRT circuits and mechanisms to choice of catheters and membranes

Outcome 7B: Vascular Access for CRRT
Analyse the optimal vascular access sites for CRRT including indications and contraindications in specific circumstances.

Evaluate the risk of and requirements for central venous catheter (CVC) insertion and create checklists and protocols to facilitate safe and effective practice.

Analyse the anatomy and physiology relevant to the choice of optimal vascular access for an individual patient.

Analyse the key risk associated with dialysis catheter insertion and how these may be mitigated / minimised.

Evaluate the key features of strategies to prevent catheter-related bloodstream infections (CRBSIs).

Outcome 7C: Prolonged intermittent RRT (PIRRT) “Sustained Low-Efficiency Dialysis (SLED)”
Analyse the key features of PIRRT and evaluate its role in patient scenarios and ICU settings

Outcome 7D: Renal Replacement Therapy (RRT)
Indications and Complications

Analyse ‘absolute indications’ to start CRRT and critically evaluate how these are employed in practice

Evaluate the benefits and risks of commencement of RRT in anticipation. Of absolute indication.

Analyse the risk and importance of short medium and long term complications of RRT and evaluate how these affect clinical decision making

Outcome 10: Extracorporeal Life Support (ECLS) and Renal Considerations
Apply understanding of basic concepts of ECMO and other ECLS and analyse and compare strategies to incorporate RRT with these therapies including vascular access, anticoagulation, circuit set up and alarms and specific complications.

• AKI diagnosis and staging and the role of biomarkers
• Prescribing in AKI and RRT
• CRRT Modalities, Membranes and Principles of Dosing
• CRRT prescriptions
• Clinical evaluation of AKI
• Alarms & trouble shooting on CRRT device
• Fluid assessment and management in AKI
• Perform the set-up of CRRT devices
• Management of hepatorenal syndrome
• Management Citrate of Anticoagulation on CRRT
• Tumour lysis syndrome cases
• CRRT integration with ECMO
• Kidney-organ interactions in critical illness and crosstalk
• The role of the kidney in acid-bas homeostasis during critical illness
• Prolonged intermittent RRT (PIRRT)
• Blood Purification Techniques in Sepsis and Hyperinflammation

An application has been made to the UEMS EACCME® for CME accreditation of this live event.