Learning Objectives

• To describe the characteristics of ESKD patients treated with dialysis in the United States and internationally and to review unique transitions in the care of dialysis patients.
• To summarize developments regarding incenter hemodialysis, home-suitable dialysis, and dialysis methods.
• To discuss management challenges, including anemia, nutrition, cardiovascular disease, and infectious complications, in patients undergoing dialysis.

Disclosure Information

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.

EDITORS:

Alice M. Sheridan, MD—Current Employer: Brigham and Women’s Hospital

Martina M. McGrath, MBChB, FASN—Current Employer: Brigham and Women’s Hospital; VA Boston Medical Center

EDITORAL AUTHOR:

Christopher T. Chan, MD—Current Employer: Toronto General Hospital, University Health Network; Consultancy Agreements: Medtronic, Quanta, DaVita; Research Funding: Medtronic through their external grant program; Scientific Advisor or Membership: Medtronic, Quanta, DaVita

AUTHORS:

Osama El Shamy, MD—Current Employer: Vanderbilt University Medical Center; Other Interests/Relationships: Home Dialysis University - Faculty

Winston Ws Fung, MBChB—Current Employer: Prince of Wales Hospital

Thomas A. Golper, MD, FASN—Current Employer: Vanderbilt University Medical Center; Consultancy Agreements: Akebia, NxStage; Honoraria: UpToDate, Akebia, NxStage, Renal Research Institute, Reata, Mallinkrodt, Home Dialysis University; Scientific Advisor or Membership: NxStage, Akebia, Reata, Mallinkrodt; Other Interests/Relationships: Course Director - Home Dialysis University, Section Editor for Dialysis UpToDate

Holly M. Koncicki, MD—Current Employer: Mount Sinai Hospital; Honoraria: Author - UpToDate

Philip K.T. Li, MD—Current Employer: Prince of Wales Hospital; Consultancy Agreements: Fibrogen, Advisory Board Co-Chair: Treatment of Anemia in Peritoneal Dialysis Patients: What is the Asia Pacific Experience?; Honoraria: Astra Zeneca - symposium moderator, Asian Pacific Congress of Nephrology Oct 2020; Scientific Advisor or Membership: KI, PDI, Fibrogen Advisory Board Meeting on Anemia in PD Patients (2019 Co-Chair); Other Interests/Relationships: Immediate Past President, Asian Pacific Society of Nephrology; President, International Association of Chinese Nephrologists

Jack Kit-Chung Ng, MBChB—Current Employer: Prince of Wales Hospital; Other Interests/Relationships: Chairman, Young Nephrologist Committee, Asian Pacific Society of Nephrology; Council Member, Young Nephrologist Committee, Hong Kong Society of Nephrology

Andreas Pierratos, MD—Current Employer: University of Toronto; Honoraria: UpToDate - Card Authorship (Walters Kluwer)

Athanasios K. Roumeliotis—Current Employer: Achilleion Nephrology Center, Thessaloniki, Greece; 1st University Internal Medicine Department, “Ahepa” University Hospital, Thessaloniki, Greece

ASN STAFF:

Suzanne P. Armstrong, MA—Nothing to disclose

Commercial Support

There is no commercial support for this issue.

The nephSAP editorial team and the KSAP editorial board extend their sincere appreciation to the following reviewers. Their efforts and insights help improve the quality of these postgraduate education offerings.

nephSAP Review Panel

• Mustafa Ahmad, MD, FASN, King Fahad Medical City, Riyadh, Saudi Arabia
• 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

nephSAP® provides a learning vehicle for physicians, scientists, advanced practitioners, nurses, pharmacists, and other health professionals working and training in the field of nephrology to renew and refresh their clinical knowledge, diagnostic, and therapeutic skills. This enduring material provides learners challenging, clinically-oriented questions based on case vignettes, detailed learning objectives, a series of articles that review recent publications, and an editorial on an important and evolving topic. This combination of materials enables learners to rigorously assess their strengths and weaknesses in the broad domain of nephrology.

Target Audience

Physicians, scientists, advanced practitioners, nurses, pharmacists, and other health professionals working and training in the field of nephrology.

Accreditation and AMA Credit Designation Statements

In 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.

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.

Original Release Date: August 2021

CME/MOC Termination Date: October 31, 2022

Examination Available Online: On or before August 6, 2021

Estimated Time for Completion: 10 hours 

Self-Assessment Examination

• Answers with explanations are provided with a passing score after the first and/or second attempt
• This issue will be archived in November 2022, and answers with explanations will be posted on the ASN website

Method of Participation

• Read the entire issue 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 and MOC.
• Upon completion, review your score and incorrect answers and print your certificate.

Activity Evaluation, CME and MOC

• Go to ASN eLEARNING CENTER (education.asn-online.org)
• Select MY ACTIVITIES from the left-hand navigation.
• Select the corresponding issue.
• Read all information on the Overview screen.
• Follow the onscreen instructions to:
  • Complete the Exam (i.e., post test),
  • Complete the Evaluation,
  • Claim credit/MOC, and
  • Print a Certificate

Your complete ASN Transcript is available on the ASN eLEARNING CENTER:

• Select TRANSCRIPT on the left-hand navigation.
• View course status, credits claimed, or print a certificate for completed learning activities.