Nephrology in the United States of America

Nephrology in the United States of America (USA) has grown into a major medical specialty over the past 60 years. Although the specialty includes the management of patients with acute kidney injury, the deciphering of complex acid-base disorders, and the identification and management of patients with glomerular diseases, for many of the 10,883 US nephrologists, it centers around the diagnosis and treatment of patients who have various stages of kidney disease. In the USA, there were approximately 726,000 patients on dialysis or living with a kidney transplant. The management of dialysis patients is tightly regulated by the Centers for Medicare and Medicaid Services, which also is a principal payer for the majority of dialysis and transplantation services in the USA. This chapter will examine the beginnings of the field and the history of how nephrology in the USA evolved. It will discuss how US physicians are approaching modalities of care as well as specific issues such as dialysis adequacy, arteriovenous access barriers, hospitalization rates, volume and cardiovascular disease, mineral and bone disorders, potassium management, and kidney transplantation. It will discuss various opportunities for young physicians and conclude with what lies in the future for nephrologists and more importantly for patients.