To Dialyze or Not to Dialyze? The Great Debate: Use of Renal Replacement Therapy in Patients with Acute Kidney Injury in the Context of Cirrhosis

Hepatorenal syndrome/acute kidney injury (HRS/AKI) describes the reversible, functional renal impairment that occurs in patients who have advanced liver cirrhosis, arising portal hypertension, and/or those with fulminant hepatic failure. Most commonly encountered as AKI in patients with decompensated cirrhosis, HRS/AKI is characterized by a reduction in glomerular filtration rate and renal plasma flow, in the absence of other causes of AKI. Prognosis is poor, with high mortality rates, and there are currently no approved pharmacotherapies to ameliorate the effects of HRS/AKI in the US. Should patients be nonresponsive to vasoconstrictor therapy or the severity of liver failure warrant immediate transplantation, the role of the nephrologist is critical in maintaining renal function, including the decision on whether to use renal replacement therapy (RRT). The degree of any benefit of RRT in these patients is currently unclear.

This activity will present the current evidence and positions both for and against the use of RRT in patients with HRS/AKI; participants will be presented with some patient scenarios and challenged to vote on whether they believe RRT would be beneficial in these patients.

Supported by an educational donation provided by Mallinckrodt Pharmaceuticals

Target Audience

  • Physicians 
  • Pharmacists
  • Physician Assistants 
  • Nurse Practitioners
  • Nurses  
  • Dietitians 
  • Social Workers
Method of Participation:

Learners will review the materials on accreditation information, target audience, learning objectives, and disclosure information; complete the pre-test; review the video content; complete the post-test (minimum score of 70% required; learners will only have 3 attempts to pass the post-test) and evaluation to successfully earn credit.  

If you participated in the live symposium To Dialyze or Not to Dialyze? The Great Debate: Use of Renal Replacement Therapy in Patients with Acute Kidney Injury in the Context of Cirrhosis on May 9, 2019 and claimed credit, you should not claim credit for this endured activity.

Learning Objectives

After participation in this activity, learners will be better able to:

  • Discuss guidelines and evidence for or against the use of renal replacement therapy (RRT) approaches in patients with acute kidney injury (AKI) in the context of decompensated cirrhosis
  • Describe the etiology of portal hypertension and other pathologies leading to vasoconstriction of the renal bed and development of hepatorenal syndrome (HRS) 
  • Stratify risks and benefits of pharmacologic and surgical options for patients with HRS, and how RRT initiation may be impacted by their use
  • Identify patients with HRS who may obtain benefit from short-term RRT, based on etiology and severity
Course summary
Available credit: 
  • 0.50 AANP and ANCC Pharmacology
  • 1.50 ACPE Contact Hours
  • 1.50 AMA PRA Category 1 Credit™
  • 1.50 ANCC Nurse Contact Hours
  • 1.50 ASWB Continuing Education Clock Hours
  • 0.50 ANCC Pharmacology
  • 1.50 Attendance
  • 1.50 Category I Credit for Physician Assistants
  • 1.50 CDR CPEUs
Course opens: 
06/28/2019
Course expires: 
06/28/2020
Cost:
$0.00
Rating: 
0
Faculty Disclosures:

Kevin Regner, MD, MS
Professor of Medicine
Medical College of Wisconsin
Milwaukee, WI
Disclosure: Has no financial relationships with commercial interest(s).

Juan Carlos Velez, MD
Associate Professor of Medicine
Ochsner Health System
New Orleans, LA
Disclosure: Honoraria: Mallincrodt, Otsuka

Hani Wadei, MD
Associate Professor of Medicine
Mayo Clinic
Jacksonville, FL
Disclosure: Has no financial relationships with commercial interest(s).

Planning Committee Disclosures:

Harold Szerlip, MD, FNKF
Director, Nephrology division and nephrology fellowship program director
Baylor University Medical Center
Dallas, TX
Disclosure: Honoraria: Astute Medical -self; Consulting fees: LaJolla Pharmaceuticals, Zs Pharma, Amarin

Mark Perazella, MD
Professor
Yale New Haven Hospital
New Haven, CT
Disclosure: Has no financial relationships with commercial interest(s).

Joanna Hudson, Pharm.D.
Professor, UT Department of Clinical Pharmacy & Translational Science
The University of Tennessee College of Pharmacy
Memphis, TN
Disclosure: Has no financial relationships with commercial interest(s).

Lynne Gafford, NP-C
Nurse Practitioner
Henry Ford Health System
W. Bloomfield, MI
Disclosure: Has no financial relationships with commercial interest(s).

Beth Morlang, RD, LD
Registered Dietitian
Central Florida Kidney Centers (Palm Bay)
Palm Bay, FL
Disclosure: Speaker's compensation: Keryx; Honoraria, Travel Expenses: NKF of New England

Jennifer McClain, MSW, LSW, NSW-C
Regional Lead Social Worker LA/NV
Fresenius Kidney Care
Las Vegas, NV
Disclosure: Stipend: HSAG Network 15

Marianne Neumann, RN, CNN
Clinical Manager
Albany Regional Kidney Center
Rensselaer, NY
Disclosure: Has no financial relationships with commercial interest(s).

Gail Torres, RN, MS, RD
Director of Clinical Communications
National Kidney Foundation
New York, NY
Disclosure: Has no financial relationships with commercial interest(s).

Danielle Nathan, MA
Senior Director, Professional Education
National Kidney Foundation
New York, NY
Disclosure: Has no financial relationships with commercial interest(s).

Kathryn Troy, MPH
Professional Education Manager
National Kidney Foundation
New York, NY
Disclosure: Has no financial relationships with commercial interest(s).

Declaration of Disclosure:

It is the policy of the National Kidney Foundation (NKF) to ensure balance, independence, objectivity, and scientific rigor in all CME/CE activities. Any individual who has control over CME/CE content is required to disclose to learners prior to the activity any relevant financial relationship(s) they may have with commercial interests supporting this activity or whose products or devices are discussed in this activity.  

If, on the basis of information disclosed, a perceived conflict exists, resolution will be achieved based on NKF's Disclosure and Conflict of Interest Policy.

Unlabeled/Investigational Use:

During their presentations, faculty may discuss an unlabeled use or an investigational use not approved for a commercial product. Each faculty member is required to disclose this information to the audience when referring to an unlabeled or investigational use.

In support of improving patient care, the National Kidney Foundation 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.

Physician

The National Kidney Foundation designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.5 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Nurse Practitioner and Nurse

Awarded 1.5 contact hours of continuing nursing education (includes 0.5 contact hours in the area of pharmacology).

Pharmacist

This knowledge-based enduring activity has been assigned Universal Activity Number JA0004461-0000-19-012-H01-P, for 1.5 contact hours (0.15 CEUs). To receive credit, learners must read the activity overview, learning objectives and faculty disclosures, complete the pre-test, review the content, complete the post-test with a minimum score of 70% (post-test may be taken up to 3 times) and electronic activity evaluation. An NABP eProfile ID and date of birth in MMDD format are prerequisites for receiving continuing pharmacy education credits. All credit awarded to participants must be uploaded to CPE Monitor™ within 30 days of the activity date, so pharmacists and pharmacy technicians are required to provide their e-Profile ID and date of birth (MMDD) at the time of the activity.  Please contact cmeinfo@kidney.org if you do not see activity information listed in your profile within 30 days.  For more information and to set up your e-Profile visit: www.MyCPEmonitor.net.

Physician Assistant 

The National Kidney Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AAPA accepts Category I credit from AOACCME, prescribed credit from AAFP, and AMA PRA Category 1 Credit(s)™ from organizations accredited by ACCME.  Physician Assistants may receive a maximum of 1.5 hours of Category I credit for completing this program.

Dietitian 

The National Kidney Foundation is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR).  CDR Credentialed Practitioners will receive 1.5 Continuing Professional Education Units (CPEUs) for completion of this activity/material.


Social Worker

The National Kidney Foundation Council of Nephrology Social Workers, Provider #1014, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program.  The National Kidney Foundation Council of Nephrology Social Workers maintains responsibility for the program. Social workers participating in this course will receive 1.5 continuing education clock hours.      

National Kidney Foundation SW CPE is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #0064.

Licensed social workers should contact their individual jurisdiction to review current continuing education requirements for licensure renewal.

Available Credit

  • 0.50 AANP and ANCC Pharmacology
  • 1.50 ACPE Contact Hours
  • 1.50 AMA PRA Category 1 Credit™
  • 1.50 ANCC Nurse Contact Hours
  • 1.50 ASWB Continuing Education Clock Hours
  • 0.50 ANCC Pharmacology
  • 1.50 Attendance
  • 1.50 Category I Credit for Physician Assistants
  • 1.50 CDR CPEUs

Accreditation Period

Course opens: 
06/28/2019
Course expires: 
06/28/2020

Price

Cost:
$0.00
Please login or register for a PERC account to take this course.
Disclaimer:

The faculty and National Kidney Foundation (NKF) do not recommend the use of any pharmaceutical, diagnostic test, or device outside of the labeled indications as approved by the FDA. Please refer to the official prescribing information for each product for approved indications, contraindications, and warnings.

Information contained in this NKF educational resource is based upon current data available at the time of publication. Information is intended to help clinicians become aware of new scientific findings and developments.  This NKF educational resource is not intended to set out a preferred standard of care and should not be construed as one. Neither should the information be interpreted as prescribing an exclusive course of management.

Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of information in this NKF educational resource is responsible for interpreting the data as it pertains to clinical decision making in each individual patient.

Required Hardware/software

System requirements can be found here.

Contact Information:

For any questions concerning this activity, please send an email to CMEinfo@kidney.org or call NKF at 1-800-622-9010.

To view NKF privacy and confidentiality policy as it relates to CME/CE activity, please visit http://www.kidney.org/

For additional professional education resources, contact NKF at 1-800-622-9010 or visit https://www.kidney.org/professionals