World Congress of Nephrology - A Symposium Highlights

Hyperkalemia and Health Outcomes
1 AMA PRA Category 1 Credit(s)
Launch Date:
December 15, 2015
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Nephrology, Cardiology, Internal Medicine, Family Practice

Relevant Terms:

Hyperkalemia, Heart Failure, Chronic Kidney Disease, Hypertension, Diabetes Mellitus, CVD

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.

Bif Palmer, MD

Bif Palmer, MD
Professor of Internal Medicine
University of Texas Southwestern Medical Center
Dallas, TX

Biff Franklin Palmer, MD, is Professor of Internal Medicine at UT Southwestern Medical Center, Dallas, Texas. He is board certified in internal medicine and nephrology.
Dr. Palmer received his medical degree from UT Southwestern Medical School and completed his residency in internal medicine at Walter Reed Army Medical Center, Washington, D.C. He then went on to complete a research fellowship in the Department of Nephrology at the Walter Reed Army Institute of Research and a clinical fellowship in the Division of Nephrology at UT Southwestern Medical Center-Parkland Memorial Hospital. 
Dr. Palmer has authored more than 190 articles and chapters. In addition to his work as an author, Dr. Palmer serves as editor for the Southwestern Internal Medicine Conference in the American Journal of Medical Sciences. He is an Associate editor for the American Journal of Nephrology and is on the editorial board of Clinical Nephrology and the American Journal of Kidney Disease. He is a member of the Nephrology subspecialty board for the American Board of Internal Medicine. 
A Fellow of the American College of Physicians and the American Society of Nephrology, Dr. Palmer is also a member of the Texas Medical Association, the International Society of Nephrology, the American Society of Nephrology, and the Southern Society for Clinical Investigation. He has received numerous teaching awards to include the Regents Outstanding Teaching award from the University of Texas and the Parkland Memorial Hospital Internal Medicine Housestaff Outstanding Teacher Award. He is a member of the Southwestern Academy of Teachers and has been designated as a Distinguished Teaching Professor by the University.

Matthew R. Weir, MD

Matthew R. Weir, MD
Professor and Director
Division of Nephrology
University of Maryland School of Medicine
Baltimore, MD

Matthew R. Weir, MD, is attending physician and Director of the Division of Nephrology in the Department of Medicine at the University of Maryland Hospital, Baltimore. He is also Professor of Medicine at the University of Maryland School Of Medicine.
Dr. Weir’s primary research interests include the use of antihypertensive therapy for the treatment of diabetic nephropathy, hypertensive renal injury in African Americans, blood pressure salt sensitivity, biomeasures of cardiovascular disease, and preventing allograft nephropathy in transplant recipients. He has written more than 500 manuscripts and book chapters about these topics. He has edited five books: including, “Medical Management of Kidney Transplantation” and “Hypertension”. He has presented at numerous international scientific association meetings, hospitals, and medical schools. 
Dr. Weir currently reviews manuscripts for more than 30 major medical journals, including the American Journal of Kidney Disease, the Journal of the American Society of Nephrology, and Archives of Internal Medicine. He is on the editorial board of 15 journals and is Section Editor of Current Hypertension Reports and Current Opinion in Hypertension and Nephrology and Associate Editor of the American Journal of Nephrology and Clinical Nephrology. He is supported by two NIH grants from NIDDK and investigator-initiated grants from industry. In addition, he is a member of numerous associations, including the American Society of Nephrology, the National Kidney Foundation, the American Heart Association, and the American Society of Transplantation. 
Dr. Weir received his medical degree from the University of Virginia, Charlottesville. He completed his internship and residency programs in medicine at the Waterbury and Yale-New Haven Hospitals in Connecticut, and completed his nephrology training at the Brigham and Women’s Hospital, Harvard Medical School, in Boston, Massachusetts. He then moved to the University of Maryland where he has been a full time faculty member since 1983.
1. Describe the normal physiology of potassium homeostasis, including the role of the kidneys, the colon and the renin-angiotensin-aldosterone system (RAAS)
2. Describe the incidence and patterns of hyperkalemia and describe those patient populations at highest risk
3. Communicate the clinical trial data and guideline recommendations regarding the use of RAAS inhibitors in the management of chronic kidney disease heart failure, hypertension and diabetes
4. Identify the causes of hyperkalemia and the pathophysiologic mechanisms in patients with impaired potassium excretion
5. Evaluate, compare and contrast the emerging clinical trial data on novel medications currently under development for the diagnosis and treatment of hyperkalemia
6. 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
7. Understand how to effectively manage serum potassium levels through the use of current and investigational agents in combination with serial monitoring of potassium levels.

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.
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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.
Dr. Bif Palmer has no financial realtionships to disclose
Dr. Matthew Weir has no financial realtionships to disclose
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 realtionships to disclose
Planners at ReardenCME have no financial relationships to disclose
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.
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There are no fees for participating in and receiving credit for this activity. During the period December 2015 through December 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.
A statement of credit will be issued only upon receipt of a completed activity evaluation and a completed posttest with a score of 70% or better. 
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