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CME: The recognition and diagnosis and management of anemia & hyperphosphatemia in CKD: Filtering it down to what the clinician needs to know

Activity Description / Statement of Need:

In this online, self-learning activity:

 Chronic kidney disease (CKD) affects about 15% of the general population in the United States and is the tenth-leading cause of death, accounting for 52,260 deaths in 2020. Along with the risk for end-stage kidney disease (ESKD) and cardiovascular disease (CVD), CKD has also been associated with a number of complications, including anemia and hyperphosphatemia. Anemia occurs in about 15% of patients with CKD and arises from decreased erythropoiesis and abnormal iron metabolism. Hyperphosphatemia occurs in the later stages of CKD because the kidney is the primary method by which the body maintains phosphate. This retention of phosphate leads to the development of CKD-mineral bone disorder (CKD-MBD), with the literature suggesting that hyperphosphatemia occurs in a large portion of patients on dialysis based on phosphate binder (PB) usage.

This learning activity has been designed to bring HCPs’ knowledge of the treatment and screening of anemia and hyperphosphatemia in patients with CKD up to date and to improve their competence and performance in treating it. It will walk participants through treatment pathways and review of the evidence behind therapies to treat CKD’s complications.

Target Audience:

The following HCPs: nephrologists and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in nephrology; and any other HCPs with an interest in or who clinically encounter patients with CKD.

Commercial Support Disclosure: This program is supported by educational grants from Akebia.

This activity is free of charge.

Release Date: January 04, 2022 -- Expiration Date: January 04, 2024

Faculty: Golriz Jafari, M.D.


Epidemiology and pathophysiology of CKD anemia and hyperphosphatemia

·       Epidemiology

o   Prevalence and incidence

o   Risk factors

·       Pathophysiology

o   Erythropoiesis pathways

o   Iron metabolism

o   Phosphate retention

Anemia of CKD

·       Diagnosis

o   Screening recommendations (ie, CBC, reticulocytes, ferritin, iron, TIBC, serum B12, folate, and occult blood)

o   Frequency of screening by presence of anemia and treatment type

·       Management

o   Setting hemoglobin targets

o   Transfusion

o   Iron deficiency treatment (oral vs intravenous iron)

o   Erythropoiesis-stimulating agents (when to initiate, selecting among options, approach to resistance)

o   Hypoxia-inducible factor (HIF) prolyl hydroxylase (PH) inhibitors

· Mechanisms of action

· Study results

· Potential use in clinic

o   Case study

Hyperphosphatemia of CKD

·       Diagnosis

o   Screening recommendations (ie, calcium, phosphorous, and parathyroid hormone levels)

o   Frequency of screening

·       Management

o   Setting treatment targets

o   Non-calcium-based phosphate binders

o   Calcium-based phosphate binders

o   Sodium/hydrogen exchanger isoform 3 (NHE3) inhibitor

o Mechanisms of action

o Study results

o  Potential use in clinic

·       Case study

Learning Objectives

By the end of the session the participant will be able to:

  • Discuss the prevalence of common CKD complications and the burden they place on patients.
  • Recall recommendations for effectively monitoring for anemia and hyperphosphatemia in patients with CKD.
  • Formulate a treatment plan for patients with anemia or hyperphosphatemia of CKD.
  • Describe the mechanisms of action and potential impact of emerging agents with novel mechanisms of action for the treatment of CKD anemia and hyperphosphatemia.


ACCME Activity #201809247

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.


ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.25 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.

PhysiciansFor maintenance of certification (MOC) credit, you must enter your board certification ID # and birth date correctly. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC credit for this activity. Please note: Not all activities on this site provide MOC credit. If this activity does not specify that it provides MOC credit in this section, then it does NOT provide MOC credit.


ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.25 contact hours (0.125 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-22-004-H01-P. This is an Application (A)-type activity.

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.  ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure:

Golriz Jafari, MD, Associate Clinical Professor, UCLA  School of Medicine, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Commercial Support Disclosure: This program is supported by educational grants from Akebia.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Faculty will not discuss off-label uses of a commercial product.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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Hemophilia B: Optimizing Pharmacotherapeutic Management Strategies