title: A Spanish multicentric study to evaluate the clinical activity of nephrology fellows during in-hospital on-call shifts.
abstract: BACKGROUND
  Nephrologists develop their work in diverse scenarios. A training programme must qualify trainees to assist different kinds of problems. The aim of this study was to characterize patients and pathologies that Spanish nephrology fellows face while on-call.
  
  
  METHODS
  This is a descriptive study with clinical and demographic data gathered with a form by 10 nephrology fellows of five university hospitals of Madrid (Spain), throughout their in-hospital 24 h on-call shifts in February and March 2013.
  
  
  RESULTS
  We collected 409 episodes over 338 patients, through 72 shifts. Among these, 16.7% had previous normal renal function, 24.6% chronic kidney disease, 39.5% were on dialysis and 18.2% had a kidney transplant. Most of the consults came from the emergency room (35.9%) or the previous on-call team (13.7%). Afterwards, the most usual destiny was admittance to a nephrology department (32.8%) or discharge (20.5%). The most frequent reason for consulting was a decline in renal function (31.6%) and the second motive an infection. Thirty-four episodes (8.3%) were related to dialysis access problems. Medical treatment was prescribed in 79.2% of the cases, primarily fluids (47.2%) and antibiotics (42.2%). The fellow had to place a central venous catheter in 24 cases (5.9%). Renal replacement therapy was prescribed in 19.8% of the episodes.
  
  
  CONCLUSIONS
  Specific renal reasons for consulting nephrologists are common, such as acute kidney injury or dialysis access complications. These patients benefit from a specialized approach to their problems. Clinical activities during in-hospital out-of-hours shifts are a priceless tool as part of the training programme of nephrology fellows.
authors.affiliation: Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: David
authors.initials: D
authors.lastname: Arroyo
authors.affiliation: Hospital Universitario Puerta de Hierro-Majadahonda , Madrid , Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Dominguez
authors.affiliation: Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Nayara
authors.initials: N
authors.lastname: Panizo
authors.affiliation: Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Quiroga
authors.affiliation: Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Calvo
authors.affiliation: Hospital Universitario La Paz , Madrid , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Álvarez
authors.affiliation: Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Macias
authors.affiliation: Hospital Universitario La Paz , Madrid , Spain.
authors.forename: David
authors.initials: D
authors.lastname: Menendez
authors.affiliation: Hospital Universitario de La Princesa , Madrid , Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Blazquez
authors.affiliation: Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Galan
authors.affiliation: Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Reque
keywords: nephrology fellowships; nephrology training; on-call activity