Medical Crossfire™: Understanding the Complexities of Chronic Kidney Disease in Type 2 Diabetes

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This activity is provided by Physicians’ Education Resource®, LLC.

Supported by an educational grant from Bayer HealthCare.

Credit Available

• Physicians — maximum of 1.5 AMA PRA Category 1 Credit(s)™
• Nurse Practitioners — maximum of 1.5 contact hours

All other health care professionals completing this course will be issued a statement of participation.

Target Audience

This online educational activity is directed toward primary care physicians, endocrinologists, nephrologists, nurse practitioners, physician assistants, and other health care professionals who treat patients with T2D.

Program Overview

The overall prevalence of chronic kidney disease (CKD) in the general US population is approximately 14%. Diabetes and hypertension are the leading causes. Diabetic kidney disease (DKD) may already be present when type 2 diabetes (T2D) is identified in patients. It is a silent killer, and symptoms do not manifest until more than 90% of renal function is lost. The annual mortality rate associated with kidney disease is greater than breast or prostate cancer. Unfortunately, early interventions are impeded by alarmingly low screening rates, underdiagnosis, and minimal patient awareness. Almost half of individuals with CKD also have cardiovascular disease. Cardiovascular disease risk factors such as hypertension, obesity, and hyperlipidemia multiply a diabetic patient’s demands on their kidneys, as well as elevate their risks of renal and diabetes complications.

Early diagnosis of DKD allows clinicians to optimize drug therapy to prevent progression to end-stage renal disease and aggressively manage comorbidities and complications. Although there has been little progress in the last decade for developing new treatment options for CKD, newer classes of glucose-lowering agents have demonstrated renoprotective effects and novel nonglucose-lowering agents are emerging.

During this Medical Crossfire®, a multidisciplinary panel will discuss the impact of CKD in patients with diabetes, from risk factors to guideline-based screening recommendations, followed by renoprotective strategies with new and emerging agents. A series of patient cases with increasing severity of kidney disease will exemplify the treatments and strategies for improving patient outcomes.

Benefits of Participating

• Gain a better understanding of the complex interplay between metabolic abnormalities and kidney disease
• Review the latest guidelines for screening and diagnosis of CKD
• Learn how to optimize renoprotective treatments through case presentations
• Increase awareness of treatments that have the potential to impact patient outcomes

Learning Objectives

Upon completion of this activity, participants should be able to:

• Describe recommended diagnostic practices for CKD in patients with T2D.
• Recognize the complex pathophysiology of CKD and the role of mineralocorticoid receptors in disease progression.
• Evaluate the efficacy and safety of nonsteroidal mineralocorticoid receptor antagonists and other therapies under investigation for treatment of patients with CKD.

Faculty

Accreditation Statement

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians

Credit Designation

Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physicians’ Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669, for 1.5 Contact Hours.

Disclosures of Conflicts of Interest

Stephen Brunton, MD, FAAFP

• Consultant: Advisory Board for Abbott Diabetes, Acadia, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Janssen, Merck, Mylan, Novo Nordisk, Xeris, Genentech
• Speakers Bureau: AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, Novo Nordisk.

George L. Bakris, MD

• Grant/Research Support: Bayer, Vascular Dynamics-paid to University of Chicago
• Consultant: Merck, Relypsa, AstraZeneca, Vascular Dynamics

Harold Bays, MD, FOMA, FTOS, FACC, FACE, FNLA

• Grant/Research Support: In the past 12 months, Dr Bays' research site has received research grants from AstraZeneca, Boehringer lngelheim, Bristol-Meyers Squibb, Eli Lilly, Gan and Lee, GlaxoSmithKline, Home Access, iSpecimen, Janssen, Johnson and Johnson, Merck, Novo Nordisk, Pfizer, Qualigen, and Takeda.

Lucia M. Novak, MSN, ANP-BC, BC-ADM, CDTC

• Consultant: Novo Nordisk, Sanofi, Abbott; Speakers Bureau: Novo Nordisk, AstraZeneca, Janssen, Abbott.

PER uses a blinded peer review process. The peer reviewer discloses the following: Peer reviewer has no relevant financial relationships with commercial interests to disclose.

The staff of Physicians' Education Resource®, LLC, (PER®) have no relevant financial relationships with commercial interests to disclose.

Method of Participation

Instructions for This Activity and Receiving Credit

1. You will need to log in to participate in the activity.
2. Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review audio files/content until you finish the presentation.
3. At the end of the activity, educational content/audio files will be available for your reference.
4. In order to receive a CME/CE certificate, you must complete the activity.
5. Complete the Posttest and pass with a score of 70% or higher, complete the Evaluation, and then click on “Request for Credit.” You may immediately download a CME/CE certificate upon completion of these steps.

Course Viewing Requirements

Supported Browsers:
Internet Explorer 8.0+ for Windows 2003, Vista, XP, Windows 7, Windows 8.1 and above
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 6.0+ for Mac OSX 10.7 and above

Supported Phones & Tablets:
Android 4.0.3 and above
iPhone/iPad with iOS 6.1 or above.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME/CE activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME/CE activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Disclosure of Unlabeled Use

This CME/CE activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME/CE activity is for continuing medical and nursing education purposes only and is not meant to substitute for the independent clinical judgment of a physician and a nurse relative to diagnostic or treatment options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.