Hyperkalemia MAP - A vClinic.org Mastery Assessment Program

Nephrology
Curriculum:
Hyperkalemia and Health Outcomes
Credits:
1 AMA PRA Category 1 Credit(s)™
Launch Date:
November 25, 2015
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

On a (weekly/monthly) basis how many patients at risk for hyperkalemia and heart failure do you see in your practice"

Relevant Terms:

Hyperkalemia, Heart Failure, Chronic Kidney Disease, End-Stage Renal Disease (ESRD), Diabetes Mellitus

Murray Epstein, MD, FACP, FSN

Murray Epstein, MD, FACP, FSN
Professor Emeritus, Nephrology and Hypertension
University of Miami
Miller School of Medicine
Miami, FL

Dr. Murray Epstein is Professor of Medicine at the University Of Miami Miller School Of Medicine. He was a recipient of the 1990 Distinguished Scientist Award of the National Kidney Foundation. In May 2011, he was awarded the American Society of Hypertension's prestigious Marvin Moser Award for Clinical Hypertension. Dr. Epstein was also awarded an Investigatorship of the Howard Hughes Medical Institute. He is also a member of many prestigious professional societies including the American Society for Clinical Investigation.

Dr. Epstein served as a member of the National High Blood Pressure Education Program Coordinating Committee and is a contributor to the 6th Report of the Joint National Committee. Dr. Epstein is listed in Who's who in America (59th, 60th and 61st edition) and Who's Who in Medicine.

Dr. Epstein has authored over 400 journal articles and book chapters. He served as the Editor of four editions of The Kidney in Liver Disease, and three editions of Calcium Antagonists in Clinical Medicine. Many of Dr. Epstein's publications have related to 1) the pathogenesis and management of hypertension, 2) renal function in diseases characterized by abnormal volume regulation, and 3) the role of the renin‑angiotensin‑aldosterone system, and 4) the evolving role of mineralocorticoid antagonist therapy as a means of retarding progression of chronic kidney disease and abrogating cardiovascular events in CKD patients. Dr. Epstein has also written extensively on head‑out water immersion, a unique clinical investigational model that he has defined and applied to the study of a wide range of disease states. The unique attributes of this clinical investigative model include a prompt redistribution of circulating blood volume with a consequent relative central hypervolemia, in the absence of concomitant changes in plasma composition. Dr. Epstein has successfully applied the immersion model as a clinical investigative tool to characterize the determinants of deranged volume homeostasis and renin-aldosterone, eicosanoid, kallikrein, vasopressin and ANF responsiveness in diverse edematous disorders including advanced liver diseases, chronic renal failure and hypertension. He has also utilized the immersion model to define the relative roles of volume and the renin-angiotensin axis as determinants of aldosterone responsiveness in anephric humans.

Dr. Epstein has also defined the effects of calcium antagonists on renal hemodynamics and renal function. At the preclinical level Dr. Epstein, in collaboration with his co-investigator Dr. Rodger Loutzenhiser, developed and  used the isolated perfused hydronephrotic kidney model to visualize the renal microvasculature and define the effect of interventions with calcium antagonists and a wide array of vasoconstrictors including angiotensin II and endothelin on the afferent and efferent arterioles. Dr. Epstein extended these studies to the clinical arena in order to define the effect of calcium antagonists on renal hemodynamics and as prophylactic agents to obviate acute renal failure in diverse clinical settings.   

Most recently Dr. Epstein has focused his clinical and investigative attention on the role of aldosterone/mineralocorticoid receptor activation as a pivotal determinant of both cardiovascular and renal injury in a wide array of clinical disorders including hypertension, diabetes mellitus, and chronic kidney disease, and the use of mineralocorticoid receptor blockade to reverse these adverse effects. Currently his major investigative interests focus is on mineralocorticoid receptor blockade as an intervention to abrogate progressive kidney disease, and as therapy to confer cardiovascular and renal benefits, in patients with chronic kidney disease. He has recently extended these studies to ESRD patients who are being treated by hemodialysis. As a corollary of this investigative focus, at present Dr. Epstein is actively involved in the clinical development of newer drugs to manage hyperkalemia, including patiromer.

A member of multiple editorial boards, Dr. Epstein also serves as a reviewer for numerous prominent journals and for study sections for granting agencies.
1. Describe the role various RAAS inhibitors and other therapies play in the management of heart failure and chronic kidney disease and their impact on the development of hyperkalemia
2. Describe key data for new and emerging therapies being developed for the management of sustained or recurrent hyperkalemia
3. Understand key facts about the development, diagnosis and treatment of hyperkalemia including sustained hyperkalemia related to heart failure and chronic kidney disease      
4. Outline the clinical consequences of hyperkalemia on healthcare outcomes, including those related to the appropriate use of guideline-recommended therapies for patients at high risk for cardiovascular morbidity and mortality, such as RAAS inhibitors, that may increase the risk of hyperkalemia

Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint provider-ship of Medical Education Resources (MER) and Rearden CME. MER is accredited by the ACCME to provide continuing medical education for physicians.
 
Credit Designation
Medical Education Resources designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
Disclosure of Conflicts of Interest
Medical Education Resources ensures balance, independence, objectivity, and scientific rigor in all our educational programs. In accordance with this policy, MER identifies conflicts of interest with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Conflicts are resolved by MER to ensure that all scientific research referred to, reported, or used in a continuing education activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing its learners with high-quality activities that promote improvements or quality in health care and not the business interest of a commercial interest.
 
The faculty reported the following financial relationships with commercial interests whose products or services may be mentioned in this activity:
Dr. Murray Epstein - Advisory Board Member - Relypsa, Inc.
 
The content planners reported the following financial relationships with commercial interests whose products or services may be mentioned in this activity:
Julie Johnson, PharmD has no financial relationships to disclose
Planners at ReardenCME have no financial relationships to disclose 
 
Disclaimer
The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources, ReardenCME, and/or Relypsa. The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Medical Education Resources, ReardenCME, and/or Relypsa. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.
 
This activity is jointly provided by Medical Education Resources (the learner may contact MER at 800-421-3756) and ReardenCME.
 
This activity is supported by an educational grant from Relypsa.
 
Method of Participation
There are no fees for participating in and receiving credit for this activity. During the period November 2015 through November 2017, participants must 1) read the learning objectives and faculty disclosures, 2) study the educational activity, 3) complete the posttest by recording the best answer to each question in the answer key, and 4) complete the evaluation form in the activity.
 
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