Volume 20: Issue 2 (Jan 2022): Electrolytes and Acid-Base Disorders

in Nephrology Self-Assessment Program
Guest Editor: Julian L. Seifter, MD
Editorial Director: Alice M. Sheridan, MD
Deputy Editor: Martina M. McGrath, MBChB, FASN

 

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

CME Credit Termination Date: February 28, 2023

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Learning Objectives

  • To examine recent scientific advances in our understanding of the pathophysiology of disorders of fluid, electrolytes, and acid-base balance.
  • To review how the understanding of pathophysiology can be applied to the care of patients.
  • To analyze how recent studies related to fluid, electrolyte, and acid-base disorders can be applied to clinical decision making.

It is the policy of 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.

EDITORAL AUTHOR:

Julian L. Seifter, MDEmployer(s): No additional relevant financial relationship(s) with ineligible companies to disclose.

AUTHORS:

Robert Jay Alpern, MDEmployer(s): Yale University School of Medicine; Ownership Interest: Abbott, AbbVie, Tricida, Apple, Berkshire Hathaway, IBM, Icahn Enterprises, Ford, Intel, Johnson and Johnson, Kraft Heinz, Merck, Pfizer, Verizon, Coca-Cola, UPS, Microsoft, Newell Brands, Organon, Peoples United Financial, Texas Pacific Land Corp, First Trust Nasdaq Bank, T. Rowe Price Real Estate Investor; Advisory/Leadership Role: Director of Abbott, AbbVie and Tricida. All are publicly traded for-profit; Other Interests/Relationships: Director of NewHYTES, a non-profit that uses tennis and education to help underprivileged children in New Haven.

Tushar Chopra, MD, FASNEmployer(s): University of Virginia Health System; Patents/Royalties: UpToDate

Thomas D. DuBose, Jr., MD, FASNEmployer(s): Wake Forest School of Medicine; No additional relevant financial relationship(s) with ineligible companies to disclose.

David H. Ellison, MD, FASNEmployer(s): Oregon Health & Science University, Portland VA Medical Center; Patents/Royalties: UpToDate

Namrata Krishnan, MDEmployer(s): Veterans Affairs Medical Center, West Haven, CT; Yale School of Medicine, New Haven, CT; Advisory/Leadership Role: Leadership roles within my institution, no outside paid roles; Other Interests/Relationships: NKF education committee, KSAP question writing committee.

Ruediger W. Lehrich, MDEmployer(s): Duke University Medical Center; No additional relevant financial relationship(s) with ineligible companies to disclose.

Martina M. McGrath, MBChB, FASNEmployer(s): Brigham and Women's Hospital, VA Boston Medical Center; Other Interests/Relationships: Deputy Editor, nephSAP; No additional relevant financial relationship(s) with ineligible companies to disclose.

Solomiia Savedchuk, MDEmployer(s): Duke University; No additional relevant financial relationship(s) with ineligible companies to disclose.

Zhabiz Solhjou, MDEmployer(s): Brigham and Women's Hospital; Patents/Royalties: Microneedle-Based Platform for Simultaneous Local Delivery of Drugs and Institial Skin Fluid Sampling for Management of Immune-Mediated Skin Diseases; Other Interests/Relationships: ASN member

Andrew S. Terker, MD, PhDEmployer(s): Vanderbilt University Medical Center; Consultancy: Andrew Terker consultancy fees by Ampio Pharmaceuticals; Ownership Interest: Ampio Pharmaceuticals

Naoto Tominaga, MD, PhDEmployer(s): Kawasaki Municipal Tama Hospital; Research Funding: Bayer Yakuhin, Ltd.; Chugai Pharmaceutical Co., Ltd.; Kyowa Kirin Co., Ltd.; Mitsubishi Tanabe Pharma Corp.; Otsuka Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Teijin Pharma Co., Ltd.; Honoraria: Astellas Pharmaceutical Inc.; Bayer Yakuhin, Ltd.; Baxter Ltd.; Chugai Pharmaceutical Co., Ltd.; Daiichi Sankyo Co., Ltd.; Edwards Lifesciences Corp.; Fuso Pharmaceutical Industries, Ltd.; Kissei Pharmaceutical Co., Ltd.; Kyowa Kirin Co., Ltd.; Mitsubishi Tanabe Pharma Corp.; Mochida Pharmaceutical Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; Sanwa Kagaku Kenkyusho Co., Ltd.

Joseph G. Verbalis, MDEmployer(s): Georgetown University; Consultancy: Corcept, EUSA, Otsuka; Honoraria: Corcept, EUSA, Otsuka ASN STAFF:

Suzanne P. Armstrong, MAEmployer(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

  • 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

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.

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: January 2022

CME/MOC Termination Date: February 28, 2023

Examination Available Online: On or before January 30, 2022

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 March 2023, 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.

 

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.
 

 

Volume 20: Issue 2 (Jan 2022): Electrolytes and Acid-Base Disorders

in Nephrology Self-Assessment Program