Twitter debate highlights ongoing challenge facing interventional nephrology

A recent Twitter exchange cast light on the heated opinions of physicians providing interventional care for patients with kidney disease. In particular, questions were raised about which group—interventional radiologists or interventional nephrologists—were best placed to deliver this care, a continuing controversy which prompted a small but passionate wave of responses. Several physicians made the case for moving past “siloed” or “tribal” thinking so that these patients receive appropriate and timely care.

That debate centred on a thread in response to a Twitter post by interventional nephrologist

Neghae Mawla (Dallas Nephrology Associates, Dallas, USA) querying nephrologists on what they would do when the attempted removal of a catheter results in only half of the tube coming out. Responses to the post questioned whether the procedure would best be handled by interventional radiology (IR) or nephrology specialists.

This led to some discussion over the validity of interventional nephrology (IN) as a subspecialty, with the suggestion put forward by some that IN was born in response to reimbursement issues. Debate online continues, highlighting the ongoing battle for legitimacy in the eyes of some of their colleagues facing interventional nephrologists.

Speaking to Renal Interventions at the American Society of Diagnostic and Interventional Nephrology (ASDIN) 19th Annual Scientific Meeting (17–19 February, Orlando, USA) Brian Rifkin (Hattiesburg Clinic, Hattiesburg, USA) addressed criticisms of IN, saying: “As interventional nephrologists we talk about the whole patient, and not just their access. That might include end-of-life issues or peritoneal dialysis. This perspective means, as a nephrologist, I am patient-centred and not just procedure-centred. Anybody can do procedures—and the reality of interventional nephrology is that lots of different specialties overlap to do procedures in dialysis patients. The difference, in my opinion, is that we see the whole patient and take ownership of that relationship.”

Vascular surgeon Robert Shahverdyan (Asklepios Clinic Barmbek, Hamburg, Germany), who was among the respondents to the original Twitter thread in defence of IN, told Renal Interventions: “Personally, I was saddened to see disagreement online on this question of who is best-equipped to treat patients. Everyone would benefit from a cooler-headed debate.

“It is clear that we need to support each other as a medical community. This community takes care of increasing numbers of complex patients in the dialysis access field, and we need to avoid division and scepticism towards each other’s specialties. Only together we