Prepared by the Education Advisory Committee of the International Society of Nephrology.

1. Objective:
   This document provides recommendations for the training of a nephrologist, defined as a physician who is able to provide comprehensive care to patients with kidney disease. The recommendations set out minimum requirements for the training of nephrologists world-wide, acknowledging that regional resource constraints will influence the capacity for provision of a comprehensive training program.
    
2. Duration of program:
   1. Minimum 4 yrs; optimum 6 years (for internal medicine plus nephrology training)
   2. Number of years devoted exclusively to nephrology training:
      Minimum 2 years, optimum 3-4 years
   
    
3. Specific clinical expertise:
   
   

   Specific clinical expertise

   Trainees should gain expertise in diagnosis and management of:	Level of requirement
   a. Acute kidney failure	Essential
   b. Fluid/electrolytes/acid-base disorders	Essential
   c. Renal parenchymal diseases	Essential
   d. Hypertension and hypertensive kidney disease	Essential
   e. Chronic kidney disease (CKD)	Essential
   f. Acute peritoneal dialysis	Desirable
   g. Hemodialysis	Essential
   h. CAPD	Essential/Desirable*
   i. Transplant workup	Essential/Desirable*
   j. Post-transplant patient:
   Early management:	Desirable
   Long-term management:	Essential/Desirable*
   k. Nutrition in patients with kidney disease and patients with ESRD	Essential
   l. Urinary tract stone disease	Essential
   m. Complicated urinary tract infection	Essential

   * Level of requirement depends on regional availability of CAPD and transplantation as treatment modalities.
    
4. Clinical training program:
   
   

   Clinical training program

   Total training time devoted to	% time allocation
   a. Management of patients with kidney disease (non-ESRD), in both inpatients (including ICU) and outpatients	˜ 40%
   b. Management of patients with ESRD, including chronic hemodialysis and/or CAPD	˜ 40%
   c. Transplant nephrology	˜ 20%
   d. Research	Optional

   
    
5. Procedures:
   
   

   Procedures

   Trainee should gain expertise in the following procedures	Level of requirement
   a. Urinalysis and urine microscopy	Essential
   b. Renal biopsy	Desirable
   c. Placement of central lines/access	Essential
   d. Connect patient for hemodialysis	Desirable
   e. Placement of acute PD catheter	Optional
   f. Placement of CAPD catheter	Optional
   g. Urinary tract ultrasound	Desirable
   h. Vascular access contrast study	Optional
   i. Access/line declotting procedure	Optional
   j. Vascular access angioplasty	Optional

   
    
6. Training program resources:
   
   

   Training program resources

   Training program should have the following resources	Level of requirement
   a. Renal pathology service	Essential (EM Optional)
   b. Acute hemodialysis	Essential
   c. Acute continuous treatment (CVVH, CAVH)	Optional
   d. Acute peritoneal dialysis	Optional
   e. Chronic hemodialysis	Essential
   f. CAPD	Essential
   g. Ambulatory nephrology (Outpatient clinic, consultation clinic)	Essential
   h. Internet access	Desirable
   i. Library with nephrology resources	Essential
   j. Availability of imaging:
   Radiology, ultrasound	Essential
   Nuclear medicine, CT scan	Desirable

   
    
7. Faculty support:
   
   

   Faculty support

   Level of support by faculty to the trainee	Level of requirement
   Continuous direct supervision	Desirable
   Nephrologist contactable 24 hours/day	Essential

November 2004

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