Nicholas Inston

Interventional nephrology

can achieve the most important goal, which is helping our patients at a high level and in the best possible way.”

Ziv Haskal (University of Virginia School of Medicine, Charlottesville, USA) also told this newspaper: “This debate has highlighted the advantages and the drawbacks of Twitter. The ability to immediately release information or comment is certainly an advantage, but the platform is also where medical data, which requires thoughtful and detailed consideration, is compressed for better or worse into short opinion bullets.

Though Twitter is often host to vigorous debate, this sometimes takes a form that might be better suited to the conference floor. Maybe we need to cool it—and to recall that some of the best research in haemodialysis access has been authored by interventional nephrologists. Every specialty has its bell curve of practitioners and personalities.”

Also speaking to Renal Interventions on the controversy was interventional radiologist Jeffrey Hull (Richmond Vascular Institute, Richmond, USA), who said: “The things people say and do speak more to who they are, their experiences, and their biases rather than to the situation at hand. Nephrologists face the needs of patients with renal disease all day every day and have the privilege and responsibility of the care of these patients. IN appears to be developing much like interventional cardiology did in the early days. They have worked with and learned from radiologists and surgeons to increasingly provide similar services and procedures including vascular access catheters, percutaneous peritoneal dialysis catheters and percutaneous arteriovenous fistulas.

“Throughout the world, the needs of dialysis patients are great and in large part unmet. The increasing knowledge, sophistication and skills that interventional nephrologists bring directly to their patients have been invaluable to patients requiring renal replacement therapy. The specialties providing healthcare are often competitive with each other, but all provide important ideas, skills and care to our patients and should be welcome. Friends—I am friends with all involved in this fracas—can agree to disagree, but I personally root for the advancement of renal care regardless of specialty or technology.”

Editor-in-chief: Nicholas Inston | Editorial Board: Ziv Haskal, Stephen Hohmann, Robert Jones

Given the controversy surrounding interventional nephrology (IN) and interventional radiology (IR), vascular access and transplant surgeon Nicholas Inston (Queen Elizabeth Hospital Birmingham, Birmingham, UK) writes to weigh in on how to get the best outcomes for patients.

WE ARE ALL ENTITLED TO OPINIONS, but is not the patient at the centre of all of this? Necessity is the mother of invention and IN would not have had the space to develop had there been no need for it.

The overall services that deliver care for patients needing dialysis access have evolved alongside each other naturally, rather than by design. There is no international blueprint for what is the best practice. In fact, for those criticising others a look in the mirror may be needed— clinical outcomes speak volumes.

Surely the obvious central advocate for a patient with kidney disease is an expert in this condition: a nephrologist. If that nephrologist is trained and delivers interventions with acceptable outcomes it is difficult to deny that this is an appropriate model of care. As with all areas of medicine, this will need to be within an integrated multidisciplinary team which at times will require surgeons, radiologists, dialysis specialists and many others to be closely involved.

Things occasionally do get complicated. IR did not develop, nor does it exist, in isolation. At times a surgeon will be needed to sort out a complication and vice versa, and we do not start to question the existence of IR (or surgery) when such events happen. Is it not time to move the discussion on and look at the real issues to which we can apply our energies? We need to focus on improving the patient’s experience, providing better quality and better value in access care, and increasing longevity of access whilst decreasing interventions.

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Editorial contribution: Jocelyn Hudson, Will Date, Clare Tierney, Eva Malpass, Jamie Bell and Bryan Kay

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