Nephrology

Nephrology is a branch of medicine dealing with the study of the function and diseases of the kidney.

The Division consists of 11 members with primary appointments at Providence, who have responsibility for the clinical, research, administrative teaching program of the division. In addition there are nine members who are primarily based at VGH but who have Providence appointments.  The clinical program is divided into chronic kidney disease, hemodialysis, peritoneal dialysis, transplant and inpatient. These programs serve as a provincial resource for tertiary and quaternary care. There is a strong divisional research focus with success in obtaining peer reviewed funding including CIHR, BC Ministry of Health Innovation Fund and Michael Smith Foundation support. There is an extensive teaching program at the undergraduate and postgraduate level. Members of the division have key administrative positions regionally and provincially in support of renal programs.

Contact Information
The Division of Nephrology
1081 Burrard Street
Vancouver, B.C., V6Z 1Y6
Telephone: 604-806-8936
Email: dagraham@providencehealth.bc.ca

Head
Dr. David Landsberg, Division Head and Clinical Associate Professor

Members
Dr. Clifford Chan-Yan, Clinical Professor
Dr. Adeera Levin, Clinical Professor
Dr. Ron Werb, Clinical Professor
Dr. David Landsberg, Clinical Associate Professor and Head
Dr. Paul Taylor, Clinical Associate Professor
Dr. John Gill, Associate Professor
Dr. Anthony Chiu, Clinical Assistant Professor
Dr. Linda De Luca, Clinical Assistant Professor
Dr. Mercedeh Kiaii, Clinical Assistant Professor
Dr. Beverley Jung, Clinical Assistant Professor
Dr. Abeed Jamal, Clinical Instructor

Teaching
The Division is highly rated for the teaching of medical students, and residents from General Internal Medicine, Urology, and Anesthesia. St. Paul's Hospital is one of two sites for nephrology subspecialty training and there are up to 5 nephrology trainees at any one time. There is also an accredited transplant nephrology fellowship program. As an integral part of the teaching program the nephrologists give a series of morning lectures four days each week, which are repeated every two months. Bedside teaching occurs continuously. There is a weekly academic half-day for sub-specialty residents and a bi-weekly city-wide round attended by all of the academic nephrologists in the City.

Research
The Division is a leader in clinical research. Both Dr. Levin and Gill have significant protected research time. Dr. A. Levin has achieved international recognition for her research in the area of chronic kidney disease and associated co-morbidities. She has recently been awarded a BC Health Innovation Fund grant for assessing new strategies to manage patients with chronic illness; as well as securing a large grant for a Canadian study to evaluate the use of novel biomarkers in predicting the progression of CKD and associated comorbidities. In addition, Dr Levin mentors medical residents, international research fellows and local research scholars in nephrology, cardiology and associated disciplines in a variety of projects relating to CVD and CKD.

Dr. Gill has become a leading international authority in renal transplant outcomes using large databases. He is the recipient of a Michael Smith Foundation Scholar Award and is the recipient of a large CIHR grant. He is the primary investigator or co-investigator on six CIHR funded studies and author of thirteen peer-reviewed publications in 2007. Other division members are actively involved in clinical research. A full list of the current research program is below.

Clinical Services
Dr. M. Kiaii is the Physician Operations Leader of the Hemodialysis Program. The 43-station outpatient hemodialysis unit is located on the 6th floor of the Providence building and is the largest outpatient dialysis service in British Columbia. Dr. Kiaii has also developed a Vascular Access Clinic and Monitoring Program.

Dr. Jamal is the Medical Director of Inpatient Services, which has 13 inpatient beds for the renal program and 2 urology/vascular surgery beds. Six short-stay beds have been established which are used efficiently to provide treatments such as kidney biopsies, the insertion of peritoneal or hemodialysis catheters, the treatment of kidney transplant rejection and as minor surgery beds for patients who require surgery to establish an arterio-venous fistula for hemodialysis blood access.

The Home Hemodialysis Program was started in September 2004, and is led by Dr. Bev Jung. This innovative program allows patients to do hemodialysis at home on a daily basis. Following the closer to home philosophy, patients are trained in two of our Community Dialysis Units.

Dr. P.A. Taylor is the Physician Operations Leader of the Peritoneal Dialysis Program. There is an active education program to teach patients and their families the techniques of peritoneal dialysis. PHC led a regional planning process to develop peritoneal dialysis in a residential care setting. This service was implemented in Sept 2007.

A Plasma-exchange Program is run jointly by the Divisions of Nephrology and Hematology.

Dr. D. Landsberg is the Physician Operations Leader of the Kidney Transplant Program. It is one of the most active transplant programs in the country and the living donor program is consistently in the top three in Canada in terms of living donor activity. In 2006 it performed the most living donor transplants and in 2007 the third highest. In total 83 kidney transplants were performed in 2007, 32 from cadaveric donors and 51 from living donors. Following transplantation, the discharged patients are followed in the very active outpatient area on 6A, adjacent to the inpatient ward. This clinic currently follows 950 kidney transplant patients (Jan/08). There is a close liaison with Community Kidney Transplant Clinics located throughout the Province. Patients are seen at these regional clinics after their return to their own homes throughout BC. The critical barrier to the growth of the renal transplant program is the organ donor shortage. The program has developed some innovative strategies to increase living donation including a donor exchange program.

Dr. A. Levin is the Physician Operations Leader of the Kidney Function Clinic. This clinic cared for 621 patients in 2006-07. This very large patient base has facilitated the success of Dr. Levin's research program in this area. She established the Combined Cardiac Kidney Diabetes Care Clinic (CCKDC) in the context of a randomized controlled trial in April 2005. This innovative clinic is the first of its kind in Canada and will provide new information about the optimal care of complex patients. 150 patients are enrolled in this project.

The nephrologists serve six community hemodialysis units located from as far away as Powell River to Richmond, B.C. These patients now receive hemodialysis close to their homes.

For more information on Nephrology, please explore these useful websites:

BC Provincial Renal Agency (BCPRA) www.bcrenalagency.ca
BC Transplant Society (BCTS) www.transplant.bc.ca
Kidney Foundation of Canada (KFOC) www.kidney.bc.ca
Chinese Renal Association www.kidney.bc.ca