Volume 18 (2019): Issue 4 (Sep 2019): Chronic Kidney Disease and Progression

in Nephrology Self-Assessment Program
Co-Editors: Holly J. Kramer, MD; Sankar D. Navaneethan, MD
Co-Directors: Gerald Hladik, MD; Jerry Yee, MD


AMA PRA Category 1 Credits™ Available
For more information regarding CME for this issue, access the CME tab below

CME Credit Termination Date: August 31, 2021 (expired)

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CKD remains the ninth leading cause of death in the United States. Over 30 million people or approximately 15% of US adults are estimated to have stages 1–5 CKD (1). Data on cause of death are obtained from resident death certificates filed in the United States and are classified in accordance with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). Because kidney disease often coincides with multiple other chronic conditions, the contribution of kidney disease to mortality is likely underestimated.

1. Centers for Disease Control and Prevention: Chronic Kidney Disease Surveillance System website. https://nccd.cdc.gov/ckd/. Accessed January 2, 2019

Learning Objectives

  • Appraise clinical trial data examining the renal effects of various oral hypoglycemic agents 
  • Explain clinical evidence regarding CKDrelated complications
  • Evaluate new developments related to clinical risk factors and emerging biomarkers for identification and treatment of cardiovascular disease in CKD.
  • Discuss new data about weight loss interventions in CKD
  • Analyze novel methods and tools that improve care delivery models for CKD

Disclosure Information

The ASN is responsible for identifying and resolving all conflicts of interest prior to presenting any educational activity to learners to ensure that ASN CME activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of the control from commercial interests and free of bias. All faculty are instructed to provide balanced, scientifically rigorous and evidence-based presentations. In accordance with the disclosure policies of the Accreditation Council for Continuing Medical Education (ACCME), individuals who are in a position to control the content of an educational activity are required to disclose relationships with a commercial interest if (a) the relation is financial and occurred within the past 12 months; and (b) the individual had the opportunity to affect the content of continuing medical education with regard to that commercial interest. For this purpose, ASN consider the relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Peer reviewers are asked to abstain from reviewing topics if they have a conflict of interest. Disclosure information is made available to learners prior to the start of any ASN educational activity.

EDITORIAL BOARD for this Issue:

Richard J. Glassock, MDCurrent Employer: Professor Emeritus, The David Geffen School of Medicine at the University of California at Los Angeles; Consultancy: Bristol-Myers Squibb, Genentech, ChemoCentryx, Apellis, Achillion, Omeros, Ionis, Mallinckrodt, NIH, UpToDate (Wolters-Kluwer), American Journal of Nephrology, Karger Publications; Ownership Interests: Reata; Honoraria: Genentech, Karger Publications, Wolters-Kluwer (UpToDate), EcoR1; Scientific Advisor/Membership: University Kidney Research Organization, Journal of the American Society of Nephrology, American Journal of Nephrology, UpToDate, Mallinckrodt, Genentech, Apellis; Other Interests: ASN Communities; Speaker’s Bureau: Genentech

Gerald A. Hladik, MD, FASNCurrent Employer: University of North Carolina at Chapel Hill; Honoraria: Renal Research Institute; Scientific Advisor/Membership: ASN Co-Director, NephSAP, Board Member, Renal Research Institute

Holly J. Kramer, MD, MPH—Current Employer: Loyola University Medical Center; Scientific Advisor/Membership: Editorial board member: American Journal of Kidney Disease, Advances in Chronic Kidney Disease, Clinical Journal of the American Society of Nephrology, Journal of Renal Nutrition

John Paul Middleton, MD—Current Employer: Duke University Medical Center; Consultancy: Relypsa, AstraZeneca, ZS Pharma, Novo Nordisk; Research Funding: Janssen, NIDDK, Relypsa; Honoraria: Relypsa, Astra Zeneca, ZS Pharma; Scientific Advisor/Membership: Editorial Board, Advances in Chronic Kidney Disease; Steering Committee NIDDK CKD Consortium; Other Interests: Raleigh Radiology (spouse)

Sankar D. Navaneethan, MD, FASNCurrent Employer: Baylor College of Medicine; Consultancy: Independent end-point adjudication committee member for clinical trials sponsored by Bayer (ongoing) and Boehringer Ingelheim (completed); Tricida; Research Funding: Keryx; Honoraria: Bayer, Boehringer Ingelheim, Tricida; Scientific Advisor/Membership: Associate Editor, American Journal of Kidney Disease, CardioRenal Medicine; Section Editor, Current Opinion in Nephrology and Hypertension; Editorial board, Clinical Journal of the American Society of Nephrology, American Journal of Nephrology; KDIGO, Guideline writing committee member

Jerry Yee, MD, FASNCurrent Employer: Henry Ford Hospital; Consultancy: La Jolla Pharmaceuticals, Elsevier Inc., Vasc-Alert LLC, EBSCO, Merck, Reata; Ownership Interests: Vasc-Alert; Honoraria: National Kidney Foundation, Drexel University, UNC Chapel Hill, Ascension Health; Patents/Inventions: Vasc-Alert; Scientific Advisor/Membership: NKF: Editor-in-Chief, Advances in Chronic Kidney Disease journal; Editorial Board: American Journal of Nephrology, American Journal of Kidney Diseases, Heart Failure Journal, Clinical Journal of Nephrology, American Journal of Hypertension; ASN Co-Director NephSAP, EBSCO DynaMed: Section Editor; Section Editor Elsevier Ferri’s Clinical Advisor 2018 Textbook


Rohan Paul, MBBSCurrent Employer: The George Washington University School of Medicine

Dominic S. Raj, MD, MBBS, FASNCurrent Employer: The George Washington University School of Medicine; Consultancy: Carvedia,Medimmune, Kaleido, Relypsa; Research Funding: NIH, Kaleido Pharmaceuticals, Carvedia, Medimmune, Relypsa; Honoraria: Relypsa, Carvedia; Scientific Advisor/Membership: NIDDK, NHLBI, Washington Academy of Medicine, Relypsa


Gisela A. Deuter, BSN, MSA—Nothing to disclose

Commercial Support

There is no commercial support for this issue.


The Editorial Board of NephSAP and KSAP extends its sincere appreciation to the following reviewers. Their efforts and insights help improve the quality of these postgraduate education offerings.

NephSAP/KSAP Review Panel

  • Mustafa Ahmad, MD, FASN, King Fahad Medical City, Riyadh, Saudi Arabia
  • Nasimul Ahsan, MD, FASN, University of Florida and Oscar G. Johnson Veteran Affairs Medical Center, Iron Mountain, MI
  • Jafar Al-Said, MD, FASN, Bahrain Specialist Hospital, Manama, Bahrain
  • Carmichael Angeles, MD, FASN, Pharmaceutical Product Development, Wilmington, NC
  • Kisra Anis, MBBS, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
  • Naheed Ansari, MD, FASN, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
  • Nabeel Aslam, MD, FASN, Mayo Clinic Florida, Jacksonville, FL
  • Nisha Bansal, MD, University of Washington, Tulsa, OK
  • Krishna M. Baradhi, MD, University of Oklahoma, Tulsa, OK
  • Emmy Bell, MD, MSPH, University of Alabama at Birmingham, Birmingham, AL
  • Bruce E. Berger, MD, Case Western Reserve University, Cleveland, OH
  • Mona B. Brake, MD, Robert J. Dole Veteran Affairs Medical Center, Wichita, KS
  • Pooja Budhiraja, MBBS, University of Kansas Medical Center, Kansas City, KS
  • Ruth C. Campbell, MD, Medical University of South Carolina, Charleston, SC
  • Chia-Ter Chao, MD, National Taiwan University Hospital, Taipei, Taiwan
  • Chokchai Chareandee, MD, FASN, University of Minnesota, Minneapolis, MN
  • Joline L. Chen, MD, Long Beach Veteran Affairs Healthcare System, Orange, CA
  • Karen Ching, MD, Hawaii Permanente Medical Group, Honolulu, HI
  • W. James Chon, MD, University of Arkansas for Medical Sciences, Little Rock, AR
  • Jason Cobb, MD, Emory University School of Medicine, Atlanta, GA
  • Armando Coca, MD, PhD, Hospital Clínico Universitario, Valladolid, Spain
  • Scott D. Cohen, MD, FASN, George Washington University, Washington, DC
  • Beatrice Concepcion, MD,Vanderbilt University Medical Center, Nashville, TN
  • Gabriel Contreras, MD, University of Miami, Miami, FL
  • Patrick Cunningham, MD, University of Chicago, Chicago, IL
  • Kevin A. Curran, MD, Kevin A. Curran, MD, Canton, TX
  • Rajiv Dhamija, MD, Rancho Los Amigos National Rehabilitation Center, Downey, CA
  • Alejandro Diez, MD, The Ohio State University, Columbus, OH
  • John J. Doran, MD, Emory School of Medicine, Atlanta, GA
  • Randa A. El Husseini, MD, FASN, HealthPartners Medical Group, St. Paul, MN
  • Pedram Fatehi, MD, Stanford Medicine, Palo Alto, CA
  • William H. Fissell, MD, Vanderbilt University Medical Center, Nashville, TN
  • D. Kevin Flood, MD, Mike O’Callaghan Federal Medical Center, Nellis AFB, NV
  • Lynda A. Frassetto, MD, FASN, University of California at San Francisco, San Francisco, CA
  • Tibor Fulop, MD, University of Mississippi Medical Center, Jackson, MS
  • Maurizio Gallieni, MD, FASN, University of Milano, Milano, Italy
  • Duvuru Geetha, MD, FASN, Johns Hopkins University, Baltimore, MD
  • Ilya Glezerman, MD, Memorial Sloan Kettering Cancer Center, New York, NY
  • Carl S. Goldstein, MD, FASN, Rutgers University, New Brunswick, NJ
  • Basu Gopal, MBBS, FASN, Royal Adelaide Hospital, Adelaide, Australia
  • Steven Gorbatkin, MD, PhD, Emory University and Atlanta Veteran Affairs Medical Center, Decatur, GA
  • Aditi Gupta, MD, University of Kansas Medical Center, Kansas City, KS
  • Susan Hedayati, MD, University of Texas Southwestern, Dallas, TX
  • Marie C. Hogan, MBBCh, PhD, Mayo Clinic, Rochester, MN
  • Susie Hu, MD, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
  • Edmund Huang, MD, University of California at Los Angeles School of Medicine, Los Angeles, CA
  • Ekambaram Ilamathi, MD, FASN, Northwell Health, Southside Hospital, Bayshore, NY
  • Talha Imam, MD, Kaiser Permanente, Fontana, CA
  • Joshua M. Kaplan, MD, Rutgers New Jersey Medical School, Newark, NJ
  • Amir Kazory, MD, University of Florida, Gainesville, FL
  • Quresh T. Khairullah, MD, St. Clair Nephrology, Roseville, MI
  • Apurv Khanna, MD, State University of New York Upstate Medical University, Syracuse, NY
  • Yong-Lim Kim, MD, PhD, Kyungpook National University Hospital, Daegu, South Korea
  • Nitin V. Kolhe, MD, FASN, Derby Teaching Hospital NHS Trust Derby, Derbyshire, UK
  • Farrukh M. Koraishy, MD, PhD, St. Louis University, St. Louis, MO
  • Eugene C. Kovalik, MD, Duke University Medical Center, Durham, NC
  • Steven Kraft, MD, Western Nephrology, Lafayette, CO
  • Vineeta Kumar, MD, University of Alabama at Birmingham, Birmingham, AL
  • Sarat Kuppachi, MD, University of Iowa, Iowa City, IA
  • Norbert H. Lameire, MD, PhD, Gent, University Hospital, East Flanders, Belgium
  • Sheron Latcha, MD, Memorial Sloan Kettering Cancer Center, New York, NY
  • Vincent Weng Seng Lee, MBBS, PhD, Westmead Hospital, Sydney, NSW Australia
  • Paolo Lentini, MD, PhD, St. Bortolo Hospital, Bassano del Grappa, Italy
  • Oliver Lenz, MD, University of Miami Health System, Miami, FL
  • Tingting Li, MD, Washington University in St. Louis, St. Louis, MO
  • Orfeas Liangos, MD, FASN, Klinikum Coburg, Coburg, Bayern, Germany
  • Michael Lioudis, MD, Cleveland Clinic Nephrology, Cleveland, OH
  • Ajit Mahapatra, MD, The Permanente Medical Group, Santa Clara, CA
  • A. Bilal Malik, MBBS, University of Washington, Seattle, WA
  • Jolanta Malyszko, MD, PhD, Medical University, Bialystok, Poland
  • Ernest Mandel, MD, Brigham and Women’s Hospital, Boston, MA
  • Naveed N. Masani, MD, Winthrop University Hospital, Mineola, NY
  • Teri Jo Mauch, MD, PhD, University of Nebraska College of Medicine Omaha, NE
  • Hanna W. Mawad, MD, FASN, University of Kentucky, Lexington, KY
  • Ellen T. McCarthy, MD, University of Kansas Medical Center, Kidney Institute, Kansas City, KS
  • Kirtida Mistry, MBBCh, Children’s National Medical Center, Washington, DC
  • Lawrence S. Moffatt, MD, Carolinas Medical Center, Charlotte, NC
  • David B. Mount, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  • Thangamani Muthukumar, MD, Weill Cornell Medicine, New York, NY
  • Mohanram Narayanan, MD, Baylor Scott & White Health, Temple, TX
  • Macaulay A. Onuigbo, MD, Mayo Clinic, Rochester, MN
  • Rosemary Ouseph, MD, St. Louis University, Webster Groves, MO
  • Todd Pesavento, MD, Ohio State University, Columbus, OH
  • Phuong-Thu Pham, MD, David Geffen School of Medicine at UCLA, Los Angeles, CA
  • Pairach Pintavorn, MD, FASN, East Georgia Kidney and Hypertension, Augusta, GA
  • Roberto Pisoni, MD, Medical University of South Carolina, Charleston, SC
  • James M. Pritsiolas, MD, FASN, CarePoint Health - Bayonne Medical Center, Bayonne, NJ
  • Paul H. Pronovost, MD, FASN, Yale University School of Medicine, Waterbury, CT
  • Mohammad A. Quasem, MD, FASN, State University of New York Medical University, Binghamton, NY
  • Wajeh Y. Qunibi, MD, University of Texas Health Science Center, San Antonio, TX
  • Pawan K. Rao, MD, FASN, St. Joseph’s Hospital and Health Center, Syracuse, NY
  • Hernan Rincon-Choles, MD, Cleveland Clinic Foundation, Cleveland, OH
  • Dario Roccatello, MD, San Giovanni Hospital and University of Torino, Torino, Italy
  • Helbert Rondon-Berrios, MD, FASN, University of Pittsburgh School of Medicine, Pittsburgh, PA
  • Ehab R. Saad, MD, FASN, Medical College of Wisconsin, Milwaukee, WI
  • Mark C. Saddler, MBChB, Mercy Regional Medical Center, Durango, CO
  • Neil Sanghani, MD, Vanderbilt University, Nashville, TN
  • Mohammad N. Saqib, MD, Lehigh Valley Hospital, Allentown, PA
  • Hitesh H. Shah, MD, Hofstra Northwell School of Medicine, Great Neck, NY
  • Michiko Shimada, MD, PhD, Hirosaki University, Hirosaki, Japan
  • Shayan Shirazian, MD, Winthrop-University Hospital State University of New York at Stony Brook, Mineola, NY
  • Arif Showkat, MD, FASN, University of Tennessee, Memphis, TN
  • Stephen M. Sozio, MD, Johns Hopkins University School of Medicine, Baltimore, MD
  • Ignatius Yun-Sang Tang, MD, FASN, University of Illinois at Chicago, Chicago, IL
  • Ahmad R. Tarakji, MD, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
  • Hung-Bin Tsai, MD, National Taiwan University, Taipei, Taiwan
  • Katherine Twombley, MD, Medical University of South Carolina, Charleston, SC
  • Kausik Umanath, MD, Henry Ford Hospital, Detroit, MI
  • Puchimada M. Uthappa, MBBS, FASN, Columbia Asia Hospital, Mysore, Karnataka, India
  • Anthony M. Valeri, MD, Columbia University Medical Center, New York, NY
  • Allen W. Vander, MD, FASN, Kidney Center of South Louisiana, Thibodaux, LA
  • Jon R. Von Visger, MD, PhD, The Ohio State University, Columbus, OH
  • Nand K. Wadhwa, MD, Stony Brook University, Stony Brook, NY
  • Connie Wang, MD, Hennepin County Medical Center, Minneapolis, MN
  • Maura A. Watson, DO, Walter Reed National Military Medical Center, Bethesda, MD
  • Dawn Wolfgram, MD, Medical College of Wisconsin, Milwaukee, WI
  • Sri Yarlagadda, MBBS, University of Kansas Medical Center, Kansas City, KS
  • Brian Young, MD, Santa Clara Valley Medical Center, San Jose, CA
  • Mario Javier Zarama, MD, Kidney Specialists of Minnesota, Saint Paul, MN


Program Mission and Objectives

The Nephrology Self-Assessment Program (NephSAP) provides a learning vehicle for clinical nephrologists to renew and refresh their clinical knowledge, diagnostic, and therapeutic skills. This enduring material provides nephrologists challenging, clinically oriented questions based on case vignettes, a detailed syllabus that reviews recent publications, and an editorial on an important and evolving topic. This combination of materials enables clinicians to rigorously assess their strengths and weaknesses in the broad domain of nephrology.

Accreditation and AMA Credit Designation Statements

Jointly Accredited Provider LogoIn support of improving patient care, the American Society of Nephrology 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.

The American Society of Nephrology designates this internet activity (enduring material) for a maximum of 10.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Original Release Date: September 2019

CME Credit Termination Date: August 31, 2021

Examination Available Online: On or before Monday, September 16, 2019

Estimated Time for Completion: 10 hours 

Answers with Explanations

  • Provided with a passing score after the first and/or after the second attempt
  • September 2021: posted on the ASN website when the issue is archived.

Target Audience

  • Nephrology certification and recertification candidates
  • Practicing nephrologists
  • Internists

Method of Participation

  • Read the syllabus that is supplemented by original articles in the reference lists.
  • Complete the online self-assessment examination.
  • Each participant is allowed two attempts to pass the examination (>75% correct) for CME credit.
  • Upon completion, review your score and incorrect answers and print your certificate.
  • Answers and explanations are provided with a passing score or after the second attempt.

Activity Evaluation and CME Credit Instructions

  • Go to www.asn-online.org/cme, and enter your ASN login on the right.
  • Click the ASN CME Center. 
  • Locate the activity name and click the corresponding ENTER ACTIVITY button.
  • Read all front matter information.
  • On the left-hand side, click and complete the Demographics & General Evaluations.
  • Complete and pass the examination for CME credit.
  • Upon completion, click Claim Your CME Credits, check the Attestation Statement box, and enter the number of CME credits commensurate with the extent of your participation in the activity.
  • If you need a certificate, Print Your Certificate on the left.

For your complete ASN transcript, click the ASN CME Center banner, and click View/Print Transcript on the left.


Instructions to obtain American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) Points

Each issue of nephSAP provides 10 MOC points. Respondents must meet the following criteria:

  • Be certified by ABIM in internal medicine and/or nephrology and enrolled in the ABIM–MOC program...
  • Enroll for MOC via the ABIM website (www.abim.org).
  • Enter your (ABIM) Candidate Number and Date of Birth prior to completing the examination.
  • Take the self-assessment examination within the timeframe specified in this issue of nephSAP.
  • Upon completion, click Claim Your MOC points, the MOC points submitted will match your CME credits claimed, check the Attestation Statement box and submit.
  • ABIM will notify you when MOC points have been added to your record.

ABIM MOC Statement

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10.0 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 Joint Accreditation for the purpose of granting ABIM MOC credit.
MOC points will be applied to only those ABIM candidates who have enrolled in the MOC program. It is your responsibility to complete the ABIM MOC enrollment process.

System Requirements Compatible Browser and Software

The nephSAP website (nephsap.org) is formatted for cross-browser functionality, and should display correctly in all currently supported web browsers. Individual nephSAP articles are available as dynamic HTML or in Portable Document Format (PDF), which requires Adobe Reader or comparable PDF viewing software.

Monitor Settings

The nephSAP website is designed for responsive display. This means the content display will respond to the device you use and to your devices screen resolution.  

Medium or Combination of Media Used

The media used include content provided online as dynamic HTML or downloadable PDF, in addition to an online evaluation and self-assessment examination.

Technical Support

If you have difficulty viewing any of the pages, please refer to the nephSAP technical support page for possible solutions. If you continue having problems, contact ASN at nephsap@asn-online.org.


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Volume 18 (2019): Issue 4 (Sep 2019): Chronic Kidney Disease and Progression

in Nephrology Self-Assessment Program