Learning Objectives

• To discuss recent developments in the diagnosis, monitoring, and therapy of CKD -mineral and bone disorder.
• To describe new developments in calcium and phosphate physiology and pathophysiology, with updates on recent information regarding derangements of mineral metabolism in normal and decreased kidney function.
• To explain bone disease including osteoporosis and renal osteodystrophy.
• To summarize new information regarding disorders of magnesium, calcium, and vitamin D metabolism, including primary hyperparathyroidism.
• To examine recent updates in the causes, diagnosis, and therapy of hypercalcemia.
• To review recent advances in kidney stone disease.

It is the policy of the American Society of Nephrology (ASN) that all individuals in a position to control the content of ASN's educational activities are expected to disclose all their and their life spouse/partner's financial relationships with “ineligible companies” within the prior 24 months as well as other non-financial interests. (“Ineligible companies” are those whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.) Participants should note that the use of products outside U.S. Food and Drug Administration (FDA) approved labeling should be considered experimental and are advised to consult current prescribing information for approval indications.

The intent of this policy is not to prevent expert faculty with relevant relationship(s) with commercial interest(s) from involvement in educational activities, but rather to ensure that these activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of control from commercial interests and free of commercial bias. In addition, all faculty were instructed to provide balanced, scientifically rigorous, and evidence-based presentations.

ASN requires all individuals in a position to control content for this activity to complete disclosure forms on the ASN website. Responses are listed below.

Disclosures have been reviewed and assessed by ASN. All relationships with ineligible companies have been identified and all relevant financial relationships have been mitigated.

View the full ASN Conflict of Interest and Disclosure Policy: https://www.asn-online.org/education/cme/coi-disclosure.pdf.

EDITORS:

Alice M. Sheridan, MD—Employer(s): Brigham and Women’s Hospital; No additional relevant financial relationship(s) with ineligible companies to disclose.

Martina M. McGrath, MBChB, FASN—Employer(s): Brigham and Women’s Hospital; VA Boston Medical Center; No additional relevant financial relationship(s) with ineligible companies to disclose.

EDITORIAL AUTHORS:

Grahame Elder, MBBS, PhD—Employer(s): Westmead Hospital, NSW, Australia; University of Notre Dame, NSW, Australia; Garvan Institute of Medical Research, NSW, Australia; No additional relevant financial relationship(s) with ineligible companies to disclose.

AUTHORS:

Matthew J. Damasiewicz, MBBS—Employer(s): Monash Medical Centre; No additional relevant financial relationship(s) with ineligible companies to disclose.

Ana Carina Ferreira, DrMed—Employer(s): Centro Hospitalar e Universit
ario de Lisboa Central - Hospital Curry Cabral; Consultancy: Viphor; Honoraria: Viphor, Amgen; Advisory or Leadership Role: Portuguese Society of Nephrology (unpaid)

Anibal Ferreira, MD—Employer(s): Vascular Access Center of Nephrocare Lumiar; No additional relevant financial relationship(s) with ineligible companies to disclose.

Rosa M.A. Moyses, MD, PhD—Employer(s): Nephrology Division, Universidade de Sao Paulo; Honoraria: Lectures for Amgen, Accord; Other Interests or Relationships: Departamento de Metabolismo Mineral da Sociedade Brasileira de Nefrologia

Thomas Nickolas, MD, MS—Employer(s): Columbia University; Consultancy: Pharmacosmos, Alnylam; Research Funding: Amgen; Honoraria: Pharmacosmos, Alnylam; Patents or Royalties: Columbia University has licensed patents on NGAL to Abbott Diagnostics and Alere; Advisory or Leadership Role: Amgen, Pharmacosmos

Sagar U. Nigwekar, MD, MMSc—Employer(s): Massachusetts General Hospital; Consultancy: Fresenius Medical Therapies Group, Epizon Pharma, Laboratoris Sanifit, Inozyme Pharma, CSL Vifor; Research Funding: Hope Pharma, Alnylam, Laboratoris Sanifit, Inozyme Pharma; Honoraria: Inozyme Pharma, Guidepoint; Patents or Royalties: UpToDate

Jason R. Stubbs, MD—Employer(s): University of Kansas Medical Center; No additional relevant financial relationship(s) with ineligible companies to disclose.

Silvia Titan, MD, PhD—Employer(s): Mayo Clinic; No additional relevant financial relationship(s) with ineligible companies to disclose.

Jaime Uribarri, MD—Employer(s): Icahn School of Medicine at Mount Sinai, New York, NY; No additional relevant financial relationship(s) with ineligible companies to disclose.

Carsten A. Wagner, DrMed, MD—Employer(s): University of Zurich; Consultancy: Ardelyx, Medice, Chugai, Kyowa Kirin; Research Funding: Chugai; Honoraria: Medice, Kyowa Kirin, Salmon Pharma; Advisory or Leadership Role: ERA Scientific Advisory Board (Chair)

James B. Wetmore, MD, MS—Employer(s): Hennepin Healthcare; Consultancy: Ad hoc consulting for BMS-Pfizer Alliance; Research Funding: NIH (NIDDK and NHLBI), AstraZeneca; OPKO Health; Merck; Genentech, Amgen, BMS/Pfizer, GlaxoSmithKline; Honoraria: BMS-Pfizer Alliance, Vifor; Honoraria for educational activities (CME-eligible) for NephSAP (ASN) and Healio

ASN STAFF:

Suzanne P. Armstrong, MA—Employer(s): American Society of Nephrology; No additional relevant financial relationship(s) with ineligible companies 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, Volume 22, Number 1, April 2023

• Josephine Abraham, MD, MPH, FASN, University of Utah, UNITED STATES
• Olufemi A. Aduroja, MD, FASN, Texas Tech University Health Sciences Center El Paso, UNITED STATES
• Taha Ayach, MD, FASN, University of Kentucky, UNITED STATES
• Shweta Bansal, MD, MBBS, FASN, University of Texas Health at San Antonio, UNITED STATES
• Nadiesda Costa, MD, MPH, FASN, Georgetown University, UNITED STATES
• Steven M. Gorbatkin, MD, PhD, FASN, University of Washington, UNITED STATES
• Susan Grossman,MD, Brooklyn VA, UNITED STATES
• Aijaz A. Gundroo, MD, FASN, The Ohio State University Wexner Medical Center, UNITED STATES
• Swapnil Hiremath, MD, MPH, FASN, University of Ottawa, CANADA
• Nithin Karakala, MD, FASN, University of Arkansas for Medical Sciences, UNITED STATES
• Elizabeth A. Kendrick, MD, FASN, UCLA Health, UNITED STATES
• Daphne Harrington Knicely, MD, FASN, Johns Hopkins University School of Medicine, UNITED STATES
• Paul A. Kovach, MD, FASN, Columbus Nephrology, Inc., UNITED STATES
• David J. Leehey, MD, Loyola University Medical Center, UNITED STATES
• Rajil B. Mehta, MD, FASN, Starzl Transplantation Institute, UNITED STATES
• Georges Nakhoul, MD, FASN, Cleveland Clinic Foundation, UNITED STATES
• Robert Nee, MD, FASN, Walter Reed National Military Medical Center, UNITED STATES
• Sankar Narayan Niranjan, MD, FASN, Greater Hartford Nephrology, UNITED STATES
• Kevin P. O’Reilly, MD, FASN, Columbus Nephrology, Inc., UNITED STATES
• Nirupama Ramkumar, MD, MPH, FASN, University of Utah, UNITED STATES
• Rupam Ruchi, MD, FASN, University of Florida, UNITED STATES
• Gurmukteshwar Singh, MD, FASN, Geisinger Medical Center- Nephrology, UNITED STATES
• James Sondheimer, MD, FASN, Wayne State University, UNITED STATES
• Ekamol Tantisattamo, MD, FASN, MPH, University of California, Irvine School of Medicine, UNITED STATES
• Ravi K. Thimmisetty, MD, FASN, Ochsner Clinic Foundation, UNITED STATES
• Ruth L. Wintz, MD, FASN, Kidney Associates, UNITED STATES

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 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.

AMA Credit Designation Statement – Physicians: 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: April 2023

CME/MOC Termination Date: March 31, 2025, at 11:59 pm ET

Examination Available Online: On or before April 30, 2023

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 April 1, 2025, 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, CE, 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
  • IMPORTANT: select the credit type that corresponds with your designation, and
  • Print a Certificate

Your ASN Transcript is available on the ASN website:

• Go to the ASN website and log in to your ASN Profile page
• Select the CME/CE Transcript tab
• View credits claimed or print a certificate with continuing education information for completed learning activities