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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Optimizing Treatment Strategies for Chronic Kidney Disease


GOAL
To provide physicians with the most recent information on optimizing treatment strategies for chronic kidney disease.

TARGET AUDIENCE
This activity is designed for nephrologists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Identify new data linking anemia and chronic kidney disease
  • Describe the advantages that current therapies have on clinical practice
  • Understand the clinical and economic impact of anemia management
  • Recognize the prevalence of anemia in patients with chronic kidney disease

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: March 31, 2003. Expiration date: March 31, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Amgen Inc.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    Mohamed G. Atta, MD
    Assistant Professor of Medicine
    Johns Hopkins University School of Medicine
    Medical Director, 25th Street Dialysis Unit
    Gambro Healthcare Inc
    Baltimore, Maryland
    • Dr Atta reports receiving honoraria from Amgen Inc.

PARTICIPATING FACULTY

    Allan J. Collins, MD, FACP
    Professor of Medicine
    University of Minnesota School of Medicine
    Director, Nephrology Analytical Services
    Minneapolis, Minnesota
    • Dr Collins reports receiving grant/research support from, serving as a consultant to, and receiving honoraria from Amgen Inc.

    Mahesh Krishnan, MD, MPH
    Nephrologist, Virginia Nephrology Group
    Arlington, Virginia
    • Dr Krishnan reports receiving grant/research support from, serving as a consultant to, and receiving honoraria from Amgen Inc.

    Brian J. G. Pereira, MD, MBA
    Professor of Medicine
    Tufts University School of Medicine
    President and CEO
    New England Health Care Foundation
    Boston, Massachusetts
    • Dr Pereira reports receiving grant/research support from, serving as a consultant to, and receiving honoraria from Amgen Inc.

    Robert D. Toto, MD
    Professor of Internal Medicine
    Director, Clinical Nephrology
    Director, Patient-Oriented-Research in Nephrology
    University of Texas
    Southwestern Medical Center
    Dallas, Texas
    • Dr Toto reports receiving grant/research support and honoraria from, and serving as a consultant to Amgen Inc.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity contains reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty members have disclosed that their articles have referenced the following unlabeled/unapproved uses of drugs or products:

Darbepoetin alfa — Dr Krishnan

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Advances in Anemia Management in Patients with Chronic Kidney Disease
Mohamed G. Atta, MD*

This issue of Advanced Studies in Medicine features highlights of a satellite symposium and selected presentations at the 35th Annual Renal Week Meeting of the American Society of Nephrology held in Philadelphia, November 1-4, 2002.

The presentations featured in this publication focus on chronic kidney disease (CKD), the anemia of CKD, and the need for anemia management and better care of patients with CKD.

In his presentation, Brian J. G. Pereira, MD, Tufts New England Medical Center, Boston, and moderator of the satellite symposium, noted that CKD, anemia, and cardiovascular disease are interconnected, with each affecting the other adversely. He also pointed out that anemia is associated with poor outcomes in the CKD population, largely because of suboptimal anemia management and despite the availability of effective therapy such as blood transfusions, iron supplementation, and treatment with eryth-ropoietic agents.

He identifies optimization of anemia management as the first step in achieving the ultimate goal of improved outcomes in patients with CKD and decries the fact that so many patients are already anemic or severely anemic by the time they see a nephrologist for the first time and/or start dialysis.

He reiterates these points in his remarks during the Panel Discussion at the conclusion of the satellite symposium by noting that in the United States far too many patients with CKD receive no treatment to correct anemia. He urges the medical community to treat anemia, to treat it early, and to treat it aggressively to improve patient outcomes.

In his presentation, Allan J. Collins, MD, Nephrology Analytical Services and the US Renal Data System, Minneapolis, Minnesota, reviews the observational data linking anemia with poor outcomes, particularly cardiovascular disease and mortality, in patients with CKD. Key factors in this link are diabetes, which plays a major role in the progression of CKD to end-stage renal disease (ESRD), and congestive heart failure (CHF).

As Dr Collins notes, diabetes-induced ESRD is increasing in all races, with the total number of cases expected to increase in the future because of the rise in type 2 diabetes mellitus in the past 10 years. New-onset CHF is also more common in patients with CKD and anemia. He presented mortality data for CKD, CHF, anemia, and diabetes alone and in various combinations, and explained why anemia is a mortality risk multiplier in patients with CKD.

Robert D. Toto, MD, University of Texas Southwestern Medical Center, Dallas, reviews the major findings of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. The RENAAL trial found the drug was renoprotective in patients with type 2 diabetes mellitus and nephropathy and significantly reduced hospitalization for heart failure in these patients.

Dr Toto also notes that a multivariate analysis of the RENAAL trial data performed by his group identified 4 independent predictors of ESRD: proteinuria, serum creatinine, serum albumin, and hemoglobin, with low hemoglobin levels also associated with increased risk for CHF.

Mahesh Krishnan, MD, Virginia Nephrology Group, Arlington, acknowledged that in the United States the management of CKD and CKD-related anemia is suboptimal. He provides several recommendations to improve care, anemia treatment, and patient outcomes.

Dr Krishnan describes several approaches that have been used successfully in dialysis units to minimize inconsistency of care and improve outcomes. He explains that these approaches can be implemented in outpatient settings to improve care in patients with CKD. Among these approaches are the use of anemia management protocols, integrated information sources, and an empowered clinical staff.

Rounding out this issue of Advanced Studies in Medicine are highlights of the Panel Discussion that concluded the satellite symposium, selected posters presented at the American Society of Nephrology meeting, a news summary of several presentations, and a Continuing Medical Education Test.

We hope the presentations in this issue are informative as well as relevant to your clinical practice and will result in better care and improved outcomes in patients with CKD.

*Assistant Professor of Medicine, Johns Hopkins University School of Medicine; Medical Director, 25th Street Dialysis Unit, Gambro Healthcare Inc, Baltimore, Maryland.

Address correspondence to Mohamed G. Atta, MD, Assistant Professor of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 416, Baltimore, MD 21205. E-mail: matta1@jhmi.edu.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.