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On example of Kostroma Region consider Creation of structured regional nephrology service based on the following model: Nephrology Center-Nephrology Department(inpatient)-nephrology room (initial attendance) with servicing population in their neighborhood

The results of the project


 

 

 

 

 

 

 

 

 

 

 

 

 

Definition and Management of Nephrology Center

A nephrology center is created as a functional cluster of subdivisions that provide specialized (including high-tech) medical care for patients with nephrological diseases. It is formed within a medical organization that has more than one nephrology and dialysis departments.

The nephrology center is managed by an executive who is designated and relieved by a founder (chief executive) of the medical organization on the basis of which this center is created.

The position of the nephrology center’s physicians is occupied by specialists who meet the Qualification Requirements to Specialists with higher and postgraduate medical and pharmaceutical education in the sphere of health care and nephrology specialty, as approved by Order No.415n of the Ministry of Health and Social Development of the Russian Federation as of July 7, 2009 (registered by the Ministry of Justice of the Russian Federation on July 9, 2009, No.14292).

The structure and size of medical staff and other employees is set by the chief executive of the medical organization, on the basis of which the center is created, taking into account the recommended standards for medical staff of nephrology centers in compliance with Appendix 11 to the Procedure of providing medical care for adult population in the sphere of nephrology, as approved by the current order.

The nephrology center is equipped in compliance with the standard for the equipment of nephrology centers according to Appendix 12 to the Procedure of providing medical care for adult population in the sphere of nephrology, as approved by the current order.

Key Functions of Nephrology Center

  • providing specialized (including high-tech) medical care for patients with nephrological diseases;
  • case monitoring for patients with nephrological diseases;
  • keeping the list (database) of patients with renal diseases for the purpose of planning the development of nephrological care within the subject of the Russian Federation;
  • organizing programs for the screening of chronic renal diseases, detecting high-risk groups and case monitoring;
  • organizing the education for patients with chronic renal diseases and allogeneic kidney recipients;
  • adoption of new achievement and scientific developments in the sphere of medical care for patients with nephrological diseases and, primarily, wide introduction of modern techniques for the reduction of nephrological diseases’ progression into the health care practice and, particularly, into the practice of primary care physicians;
  • managerial and methodical assistance to medical organizations from the viewpoint of improving their work with nephrological patients;
  • counseling assistance to physicians of other specialties in relation to diagnostics and treatment of nephrological diseases;
  • taking part in measures oriented at the advanced training of physicians and medium-level medical personnel in the sphere of nephrology;
  • promoting a cooperative work of the nephrology service with other specialized services of the subject of the Russian Federation, including the endocrinology and cardiology services that provide medical and social assistance to patients;
  • keeping registration and report documentation, providing reports on the activity in accordance with the established procedure, collecting data for registers as required by the legislation;
  • Creation the mobile AKI treatment team for patients with acute kidney injury


Definition and Regulations of Nephrology and Hemodialysis Department
 (NHD) operation

A Nephrology and Hemodialysis Department (NHD) is managed by a head of department who is designated and relieved by the chief executive of the medical organization on the basis of which this center is created and meets the Qualification Requirements to Specialists with higher and postgraduate medical and pharmaceutical education in the sphere of health care and nephrology specialty, as approved by Order No.415n of the Ministry of Health and Social Development of the Russian Federation as of July 7, 2009 (registered by the Ministry of Justice of the Russian Federation on July 9, 2009, No.14292).

The position of a NHD nephrologist is occupied by specialists who meet the Qualification Requirements to Specialists with higher and postgraduate medical and pharmaceutical education in the sphere of health care and nephrology specialty, as approved by Order No.415n of the Ministry of Health and Social Development of the Russian Federation as of July 7, 2009 (registered by the Ministry of Justice of the Russian Federation on July 9, 2009, No.14292).

The position of NHD medium-level personnel is occupied by specialists who meet the Qualification Requirements to Health Care Professionals, as approved by Order No.541n of the Ministry of Health and Social Development of the Russian Federation as of July 23, 2010 (registered by the Ministry of Justice of the Russian Federation on August 25, 2010, No.18247).

The structure and size of NHD medical staff and other employees is set by the chief executive of the medical organization, on the basis of which the department is created, taking into account the volume of provided medical care and recommended standards for medical staff and other employees of nephrology departments in compliance with Appendices 5 and 8 to the Procedure of providing medical care for adult population in the sphere of nephrology, as approved by the current order.

The NHD is equipped in compliance with the standard for the equipment according to Appendices 6 and 9 to the Procedure of providing medical care for adult population in the sphere of nephrology, as approved by the current order.

Functions of Nephrology and Hemodialysis Department (NHD)

  • hospitalization and provision of medical care to patients with nephrological diseases in compliance with the health care standards;
  • diagnostics of nephrological diseases by means of laboratory, instrumental (ultrasound, X-ray, radiological) techniques and needle biopsy of the kidneys (it is advisable to establish a specially equipped procedure room within the nephrology department in order to perform needle biopsy of the kidneys and other manipulations);
  • provision of medical care to patients with nephrological diseases hospitalized in the intensive care units;
  • adoption of new techniques for prevention, diagnostics and treatment for patients with nephrological diseases, including modern nephroprotection methods, and their introduction into practice; conduction of the efficacy analysis in relation to the introduction of new diagnostic and treatment techniques and methods;
  • provision of rehabilitation measures for patients with nephrological diseases in inpatient settings and for allogeneic kidney recipients after their discharge from transplantation departments/ centers;
  • provision of necessary counseling assistance to physicians of other departments within a medical organization on prevention, diagnostics and treatment of renal pathologies;
  • development and conduction of measures to increase the quality of diagnostics and treatment in the Department and reduce hospital mortality because of renal diseases;
  • participation in the process of advanced training of a medical organization’s personnel in relation to diagnostics and provision of medical care for patients with nephrological diseases;
  • training of patients with chronic nephrological diseases (including schools for patients) in techniques of control and prevention of exacerbations and healthy lifestyle;
  • keeping registration and report documentation, providing reports on the activity in accordance with the established procedure, collecting data for registers as required by the legislation;
  • treating patients who require renal replacement therapy with hemodialysis and peritoneal dialysis techniques; providing concomitant medical and diagnostic assistance according to the approved standards and recommendations on the management of patients in inpatient settings;
  • preparation to dialysis therapy and formation of the dialysis access; diagnostics and treatment of dialysis access complications in the course of dialysis therapy;
  • hospitalization of outpatients on hemodialysis or peritoneal dialysis in case of medical indications (complications of the dialysis access and/ or dialysis therapy; complications of end-stage chronic renal failure including infectious, cardiovascular, etc.) and the need to correct a dialysis regimen;
  • case monitoring for patients with chronic renal failure at the predialysis stage (chronic kidney disease stage 4) and allogeneic kidney recipients with pronounced dysfunction of the transplant requiring re-initiation of dialysis therapy;
  • registration and record keeping on patients waiting for dialysis therapy, potential recipients eligible to renal transplantation and patients who underwent renal transplantation;
  • treating patients after renal transplantation in the absence of a regional transplantation center or possibility to keep them in the nephrology department;
  • provision of necessary counseling assistance to physicians of other medical organizations on diagnostics and treatment of renal failure;
  • development and conduction of measures to improve the quality of medical and diagnostic activities within a medical organization in order to reduce mortality and increase the life expectancy and life quality of dialysis patients and allogeneic kidney recipients observed by the department;
  • training of patients with chronic renal failure and their relatives in the techniques used to control and prevent complications of the dialysis access and chronic renal failure.


NHD should have the possibility of laboratory control over the quality of dialysis therapy during the course of treatment and within the inter-dialysis period; it can be performed by a centralized laboratory of the medical organization the department is based on. In the DNH for the above purposes can be a special laboratory.

Regulations of Nephrology Room Operation

The nephrology room’s structure and size of medical staff is set by the chief executive of the medical organization, on the basis of which the Room is created, taking into account the volume of provided medical care, number of the citizens covered with medical care and recommended standards for medical staff and other employees of nephrology departments in compliance with Appendix 2 to the Procedure of providing medical care for adult population in the sphere of nephrology, as approved by the current order.

The room is equipped in compliance with the standard for the equipment of nephrology rooms according to Appendix 3 to the Procedure of providing medical care for adult population in the sphere of nephrology, as approved by the current order.

The position of a nephrologist is occupied by specialists who meet the Qualification Requirements to Specialists with higher and postgraduate medical and pharmaceutical education in the sphere of health care and nephrology specialty, as approved by Order No.415n of the Ministry of Health and Social Development of the Russian Federation as of July 7, 2009 (registered by the Ministry of Justice of the Russian Federation on July 9, 2009, No.14292) and Qualification Requirements to Health Care Professionals, as approved by Order No.541n of the Ministry of Health and Social Development of the Russian Federation as of July 23, 2010 (registered by the Ministry of Justice of the Russian Federation on August 25, 2010, No.18247).

The position of the nephrology room’s medium-level personnel is occupied by specialists who meet the Qualification Requirements to Health Care Professionals, as approved by Order No.541n of the Ministry of Health and Social Development of the Russian Federation as of July 23, 2010 (registered by the Ministry of Justice of the Russian Federation on August 25, 2010, No.18247).

Functions of Nephrology Room 

  • Provision of counseling, diagnostic and medical assistance to patients with nephrological diseases and the high-risk group’s representatives referred by primary care physicians, general practitioners (family physicians), medical specialists and physicians of medical organizations that have no nephrology room in their structure;
  • Follow-up care and rehabilitation for patients with nephrological diseases and patients characterized with a high risk of renal injury;
  • Examination of patients aged over 60 with latent nephrological diseases and patients with diabetes mellitus (if the disease length is over 5 years), arterial hypertension and widespread arteriosclerosis, including coronary heart disease and cerebrovascular disease;
  • Selection and referral of patients to undergo inpatient treatment in specialized medical organization for specialized (including high-tech) medical care (renal transplantation) for patients with nephrological diseases;
  • Determination of the time to initiate renal replacement therapy and provision of consultations to patients in relation to the selection of techniques (hemodialysis, peritoneal dialysis, preventive/ predialysis renal transplantation); record keeping on patients who wait or undergo dialysis therapy and allogeneic kidney recipients;
  • Collection and analysis of the main medical statistical indicators of the incidence, disablement and mortality (outside and inside the medical organization) for nephrological diseases in the territory under care;
  • Organization and participation in the screening of chronic renal diseases together with primary care physicians, general practitioners (family physicians) and cardiologists, including examining relatives of patients diagnosed with chronic renal diseases and patients with arterial hypertension, widespread arteriosclerosis and diabetes mellitus;
  • Conduction of measures oriented at the prevention of nephrological diseases in representatives of the risk group and introduction of modern techniques of prevention, diagnostics and treatment of chronic kidney disease into the practice of primary care physicians;
  • Arrangement of expert evaluation to verify temporary disability;
  • Referral of patients with persistent disability signs to undergo medical-social expert evaluation;
  • Provision of counseling assistance to physicians of other specialties on diagnostics, treatment and prevention of nephrological diseases;
  • Development and implementation of personal, social and health education measures;
  • Organization and provision of education for patients with chronic kidney disease and allogeneic kidney recipients;
  • Participation in measures oriented at advanced training of physicians and medium-level medical personnel on nephrology;
  • Keeping registration and report documentation, providing reports on the activity in accordance with the established procedure, collecting data for registers as required by the legislation.