Hyperkalemia and Health Outcomes: A vClinic.org HFSA Symposium Highlights - Part 1

Hyperkalemia and Health Outcomes
1 ANCC Contact Hours 1 AMA PRA Category 1 Credit(s)
Launch Date:
April 05, 2016
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Physicians, PAs, NPs, and Nurses and other healthcare professionals involved in the treatment of hyperkalemia.

Relevant Terms:

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

Murray Epstein, MD, FSACP, FSN

Murray Epstein, MD, FSACP, 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.

Daniel Duprez, MD, PhD

Daniel Duprez, MD, PhD
Professor of Medicine; Donald and Patricia Garofalo Chair in Preventive Cardiology
University of Minnesota
Minneapolis, MN

Dr. Duprez received his medical degree from the University of Ghent in Belgium where he also completed his and residency. He completed fellowship programs at both the University of Ghent and the Mayo Clinic.
Dr. Duprez was elected to the National Lipid Association Board of Directors and was elected as a member of the American Society Hypertension Publications Committee.
His philosophy is “to provide outstanding comprehensive care to patients with cardiovascular disease, including a number of emerging technologies available at the University of Minnesota Medical Center-Fairview. My practice combines state-of-the-art therapies, compassion, and effective communication, creating a working partnership that results (overall) in high quality of life for my patients."
Dr. Duprez has numerous publications to his record and is also fluent in Dutch, English, French, and German.

Bertram Pitt, MD

Bertram Pitt, MD
Professor Emeritus
University of Michigan School of Medicine
Ann Arbor, MI

Dr. Pitt, a graduate of the Medical School of the University of Basel (Switzerland), is Professor of Internal Medicine, University of Michigan School of Medicine. Before that, he spent 15 years as the Director, Division of Cardiology, University of Michigan School of Medicine.

Dr. Pitt’s research is in practically all areas of cardiovascular disease, with special emphasis on the ischemic heart disease and heart failure. Dr. Pitt is author of close to 500 papers and chapters in books and is Member of the Editorial Board on a number of Journals in cardiovascular diseases.
Dr. Pitt received his postdoctoral training at Beth Israel Hospital Boston and the Johns Hopkins Hospital University, and then joined the Faculty of the John Hopkins University. He joined the University of Michigan in 1977 as the Professor of Internal Medicine and Director of the Division of Cardiology.
He is a member of numerous professional societies and has held office in several of them. Among others, he was Chairman, Council on Circulation of the American Heart Association, President of the Michigan Chapter of American College of Cardiology, Chairman, Young Investigator’s Award Committee of the American College of Cardiology, and is currently Chairman of the Reveal Committee of the ACC.

Dr Pitt has distinguished himself as the Principal or Co-principal Investigator of a number of clinical trials, such as the Digitalis-Captopril Trial (300 patients), Studies of Left Ventricular Dysfunction (SOLVD - 6,700 patients), Pravastatin Limitation of Atherosclerosis in the Coronary Arteries (PLAC Study - 600 patients), QUIET Study (1,750 patients), Prevent Trial (600 patients), Reflect II Trial (300 patients), RALES trial (3,200 patients), Ephesus (6,400 patients) and ELITE II (3,000 patients).
1. 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.
2. 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. 

Statement of Need/Program Overview
Recurrent hyperkalemia represents a direct and indirect risk by hampering the ability of physicians to maintain RAASi therapy in appropriate patients. Newly approved and emerging potassium binders offer the opportunity to manage recurrent hyperkalemia while maximizing the use of guideline-mandated RAASi therapies proven to help patients with heart failure, hypertension, diabetes, and chronic cardiorenal disease. The Hyperkalemia and Healthcare Outcomes curriculum was designed to help physicians rapidly transform this new knowledge into meaningful actions and improved outcomes for their patients.
Learning Goal/Purpose
This activity is designed to assist learners in reviewing key aspects in the evidence- and guidelines-based diagnosis and treatment of patients with heart failure and hyperkalemia.
Educational Objectives
After completing this activity, the participant should be better able to:
  1. 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.
  2. 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.
Program Agenda
This activity will cover topics such as:
•Angiotensin peptides and receptors
•Tissue RAS
•The beneficial effects of RAAS inhibitors
•MRAs and RAS-Inhibitors in patients with heart failure: proven benefits but sub-optimal use
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 ReardenCME. 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™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing Credit
Medical Education Resources is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
This CE activity provides 1 (one) contact hour of continuing nursing education.
Medical Education Resources is a provider of continuing nursing education by the California Board of Registered Nursing, Provider #CEP 12299, for 1 (one) contact hour.
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:
Murray Epstein, MD has participated in Advisory Boards for Relypsa, Inc.
Daniel Duprez, MD has no financial relationships to disclose.
Bertram Pitt, MD serves as a Consultant for Relypsa, Inc.
The content managers 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.
Content planners at ReardenCME have no financial relationships to disclose.
Method of Participation
There are no fees for participating in and receiving credit for this activity. During the period April 2016 through April 2018, 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 65% or better. 
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 Pharmaceuticals. 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.
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