Crucial Conversations in Nephrology: Management of Anemia in CKD Using an Interdisciplinary, Patient-Centered Approach
June 30, 2019
June 30, 2020
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This activity is provided by American Academy of CME, Inc.
Supported by an educational grant from AstraZeneca.
- Physicians — maximum of 1.5 AMA PRA Category 1 Credit(s)™
- Nurses — 1.5 contact hours (1.0 pharmacotherapeutic contact hours)
All other health care professionals completing this course will be issued a statement of participation.
This activity is designed for nephrologists, nephrology nurse practitioners, physician assistants, and primary care clinicians.
Anemia is a common condition in patients with chronic kidney disease (CKD) and its treatment is often challenging due to concerns regarding the safety of current agents, non-responsiveness to current agents, lack of consensus regarding treatment targets, controversy regarding balance between a patient-centric approach vs. the use of one-size-fits-all algorithms, and suboptimal coordination between members of the healthcare team managing the anemia.
Although erythropoietic stimulating agents (ESAs) replace deficient native erythropoietin (EPO) in patients with CKD, ESAs do not address iron absorption and mobilization defects that frequently occur in patients with CKD that may blunt the effectiveness of ESA therapy. Hypoxia-inducible factor (HIF) stabilizers are an emerging class of agents currently being investigated to treat CKD-associated anemia which not only stimulate the production of endogenous EPO in renal and non-renal tissues but also increase the production of a variety of proteins which improve iron absorption from the gastrointestinal (GI) tract and iron mobilization from stores to the erythroid marrow, leading to more complete stimulation of the erythropoietic apparatus. The success of employing current (and future) treatments to optimize outcomes for patients with CKD who have anemia falls on the members of the interdisciplinary nephrology care team.
Upon completion of this activity, participants should be able to:
- Review the causes and underlying pathophysiology of anemia in patients with CKD
- Assess current options for treating anemia in patients with CKD
- Describe the role of PHI/HIF in CKD anemia and the rationale for developing therapy that targets PHI
- Evaluate emerging data and clinical implications of HIF stabilization as a strategy to address anemia in CKD
- Review the roles of the interprofessional, multi-disciplinary care team while identifying barriers and develop solutions to optimize the team approach
Jay Wish, MD
Medical Director, Out-Patient Dialysis Unit
Indiana University Hospital
Professor of Clinical Medicine
Indiana University School of Medicine
Chilnille Milbrooks, NP-C
Indiana University Health
In support of improving patient care, American Academy of CME, Inc. is Jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
American Academy of CME, Inc designates this enduring material for 1.5 AMA PRA Category 1 Credit(s)™.
American Academy of CME, Inc. designates this educational activity for 1.5 nurse contact hours (1.0 pharmacotherapeutic contact hours).
American Academy of CME, Inc is a provider of California Board of Nursing credit. California provider number CEP16993.
Per the AAPA, PAs attending an educational activity that has been designated for AMA PRA Category 1 Credit(s)™ may claim up to the maximum number of credits designated.
Disclosures of Conflicts of Interest
Jay Wish, MD, has the following relevant financial disclosures to report:
- Advisory Board for Marketing Purposes: Akebia, AstraZeneca, Vifor
- Consultant: Akebia, Spherix Global Insights, AstraZeneca, Vifor, Otsuka, Nabriva, Zydus
- Promotional Speakers Bureau: Pfizer, Keryx
Chilnille Milbrooks, NP-C,has no relevant financial relationships with any commercial interests.
John JD Juchniewicz, MCIS, CHCP; Natalie Kirkwood, RN, BSN, JD, Lead Nurse Planner; Paul Miniter, MS; and Wendy Gloffke, PhD – American Academy of CME: No relevant financial relationships with any commercial interests.
Michelle L. Kohute, PharmD, BCCCP (independent reviewer) has no relevant financial relationships with any commercial interests.
Instructions for Participatin and Credit
There are no fees to participate in the activity. Participants must review the activity information including the learning objectives/learning outcomes and disclosure statements, as well as the content of the activity.
To receive CME/CNE credit for your participation, please use the link below to complete the post-test (achieving a passing grade of 70% or greater), and program evaluation. Your certificate can be printed immediately.
Hardware and Software Requirements
Participants will need to have QuickTime, Windows Media Player, or VLC to view the program.
Disclosure of Investigational Use
This activity will review investigational information regarding agents not currently approved by the US FDA.
Iron isomaltoside is an IV iron preparation that is approved in Europe for administration of a single dose of 1000 mg. It is undergoing phase 3 trials in the United States for a variety of iron deficiency anemia indications.
Roxadustat, vadadustat and daprodustat are among a new class of agents called hypoxia-inducible factor (HIF) stabilizers, which are being evaluated to treat anemia in the US.
The opinions expressed in this educational activity are those of the faculty, and do not represent those of Academy, or American Nurses Credentialing Center’s Commission on Accreditation. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.
For any questions, please contact: CEServices@academycme.org.
©2019. This CME/CNE-certified activity is held as copyrighted © by American Academy of CME. Through this notice, the Academy grants permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owner(s).
CKD Anemia Monograph Resources
- Renal Patient and Provider Perspectives on Kidney Disease and Anemia. American Kidney Fund. Available at http://www.kidneyfund.org/anemia/anemia-survey/?utm_campaign=actonanemia&utm_medium=referral&utm_source=wishpond190207#request-report
- Clinical Tools. National Kidney Foundation. Available at https://www.kidney.org/professionals/tools
- Issues in Iron Management in the Hemodialysis Patient. Available at https://www.kidney.org/sites/default/files/02-10-6796_IBE_IronManagement_Bulletin_Print_1.pdf
- CKD-MBD and Anemia: Benefits and Risks Associated with Common Therapies. Available at https://www.kidney.org/sites/default/files/02-10-6786_HBE_AnemiaCKD-MBD_Bulletin.pdf
- Educate Your Dialysis Patients About Anemia - Talking Points Card. Available at https://www.kidney.org/sites/default/files/12-10-4750_BC_AnemiaManage_TalkingPoints_11F.pdf