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Clinical Diabetes Digital Publication


Anemia in Chronic Kidney Disease in Primary Care


Stephen Brunton, MD, FAAFP, CDCES, Editor in Chief, Clinical Diabetes, Executive Director, Primary Care Metabolic Group, Winnsboro, SC
Steven Fishbane, MD, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
Jennifer D. Goldman, PharmD, CDCES, BC-ADM, FCCP, Massachusetts College of Pharmacy and Health Sciences, Boston, MA
Eugene Wright, MD, Department of Medicine, Duke University School of Medicine, Durham, NC

Chronic kidney disease (CKD) is prevalent among people with diabetes. Many people with CKD suffer from anemia as a complication. Despite its prevalence in CKD, anemia tends to be an underrecognized and undertreated condition in this population. Since the 1980s, effective treatments to correct anemia have been available. Additionally, newer treatments are on the horizon that have the potential to provide additional therapy options to improve outcomes for patients with anemia in CKD.

Despite the simplicity of identifying anemia and CKD based on routine laboratory measures, both conditions can be underrecognized in primary care. Since CKD is frequently asymptomatic, patients will not likely complain of symptoms related to kidney disease (such as fatigue related to anemia) until more advanced stages. This series of presentations is designed to broaden the understanding, diagnosis, and treatment for anemia in CKD, including a discussion of evolving treatments for anemia in CKD, empowering clinicians, and easing patient burden. 

The videos can be viewed in their entirety below, and an executive summary of the panel’s recommendations is available on the Clinical Diabetes website at https://doi.org/10.2337/cd22-0054 or by clicking the thumbnail to the left.

This peer-reviewed publication was developed in adherence with Good Publication Practice (GPP3) guidelines. All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and have disclosed all potential conflicts of interest.

 

 


Learning Objectives


  • Discuss methods to improve recognition of anemia in CKD.
  • Explain the importance of early management of anemia to reduce symptoms and adverse outcomes in patients with CKD.
  • Implement appropriate treatment for patients with anemia in CKD who can be adequately managed in the primary care setting.
  • Describe evidence for emerging agents being studied in clinical trials for anemia in CKD.

  • Accreditation and Certification


    Primary Care Education Consortium is accredited by the ACCME to provide continuing medical education for physicians. Each video episode is certified for 0.25 AMA PRA Category One Credits™. This enduring material is designated for a maximum of 0.75 credits for viewers of all three episodes. Healthcare professionals should claim only the credit commensurate with the extent of their participation in the activity. CME is available from 9 September 2022 to 9 September 2023.

    To receive 0.75 CME credits for viewing all three videos, click Get Credit below.

    To receive 0.25 CME credits for viewing an individual video, click the corresponding survey link below.

    Part One Survey: Identifying and Managing Anemia in CKD
    Part Two Survey: How to Prescribe and Monitor ESAs for Anemia in CKD 
    Part Three Survey: Novel Emerging Agents for Anemia in CKD

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    About the Authors

    Stephen Brunton, MD, FAAFP, CDCES, is the Executive Director of the Primary Care Metabolic Group and Executive Vice President  for the Primary Care Education Consortium. He works in a group practice in rural South Carolina. He holds the faculty rank of Adjunct Associate Clinical Professor at Touro University in Vallejo, California. He currently also serves as the Editor in Chief for Clinical Diabetes.

    Dr. Brunton earned his medical degree at Monash University Medical School in Melbourne, Australia, and completed his residency in family practice at Long Beach Memorial Medical Center in California. He is a board-certified family physician, with a certificate of added qualifications in geriatrics. He is a former president of the California Academy of Family Physicians and the Association of Family Medicine Residency Directors and has held many positions within the American Academy of Family Physicians. He served as director of the Division of Education in the early 1980s and was a family practice residency director in California for 13 years.

    A frequent lecturer, Dr. Brunton also has published numerous articles, chapters, and monographs on family medicine and related clinical topics. He has served as a reviewer for American Family Physician, CMRO, Southern Medical Journal, Expert Review of Endocrinology and Metabolism, and the Journal of Family Practice.

     

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    Steven Fishbane, MD, is the Chief of Nephrology of Hofstra/Northwell Health and Professor of Medicine at the Zucker School of Medicine at Hofstra/Northwell. As a nephrologist with over 25 years of clinical experience and as a medical researcher with more than 255 peer-reviewed publications, he understands and has studied many of the issues involved with complications of CKD and issues with decision-making related to end-stage kidney disease. He has served as global study lead for important trials in nephrology, including the current DIALIZE-Outcomes Study. An important part of his work has been as medical director for five different dialysis facilities and current Chief Medical Officer for the True North Dialysis Centers in New York. He is also Medical Director for the Healthy Transitions in Advanced Kidney Disease Program. He has been the recipient of multiple honors and holds several appointments, including to the National Quality Forum’s Standing Committee of Admissions and Readmissions. Through his clinical research, Dr. Fishbane has become renowned for advancement and innovation in the treatment of CKD patients. Dr. Fishbane received his MD and trained in nephrology at Albert Einstein College of Medicine.

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    Jennifer D. Goldman, PharmD, CDCES, BC-ADM, FCCP, has been a pharmacist for over 30 years and joined the faculty at the Massachusetts College of Pharmacy (MCPHS) in 1997.  She received her BSPharm in 1989 and her PharmD in 1996, both from MCPHS.  She completed a residency with a focus in ambulatory care at the Boston VA Medical Center in 1997. She is a certified diabetes care and education specialist and is board certified in advanced diabetes management. She is a fellow of the American College of Clinical Pharmacists.  Dr. Goldman is currently a Professor of Pharmacy Practice at MCPHS in Boston, MA, and coordinates and teaches in the pharmacy and physician assistant programs. She has maintained a practice in family and internal medicine with a focus in cardiometabolic disease since 1997, and she works at Well Life Medical in Peabody, MA. She is a clinical and academic preceptor for MCPHS PharmD candidates, fellows, and residents.  She has served on various statewide and national organizational committees and boards. Dr. Goldman has been the recipient of the Long Term Service, Trustees Award for Teaching Excellence, the Preceptor of the Year, the Pharmacy Practice Teacher of the Year, and the Biopharmaceutical Industry Fellowship Faculty Preceptor of the Year at MCPHS and has been recognized by the American Academy of Family Physicians for teaching in family medicine.  Her research interests are in the area of diabetes/cardiovascular disease and the scholarship of teaching, with numerous publications and invited presentations in these areas.

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    Eugene Wright, MD, holds appointments as Consulting Associate in the Department of Medicine of Duke University Medical Center. He has over 40 years of clinical experience as a private practitioner, academic clinician and educator, medical administrator, rural physician in southeastern NC, and volunteer physician. He has worked with the Charlotte AHEC in Performance Improvement since 2018. Dr. Wright serves as an Associate Editor of Clinical Diabetes and has served on several advisory and editorial boards, including for Diabetes Technology and Therapeutics and as a content reviewer for UpToDate. Dr. Wright has served on the Planning Committee of the Clinical Conference of the ADA since 2009. He served as the inaugural chair of the ADA Primary Care Interest Group and as a member of the ADA/AHA Know Diabetes by Heart Science Advisory Group. Dr. Wright has published several articles on diabetes diagnosis, treatment, and management and has given presentations at national and international meetings on new treatments and technologies for diabetes. Dr. Wright has an undergraduate BSE in Electrical Engineering from Princeton University and a medical degree from Duke University School of Medicine. He completed his internship and residency in Internal Medicine at Duke University Hospital in 1981.

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    Information

    Disclosures

    Primary Care Education Consortium adheres to the conflict-of-interest policy of the ACCME and the AMA. All individuals in a position to control the content disclose any relationships they may have with commercial companies whose products or services may be mentioned so that participants may evaluate the objectivity of the presentations. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Only participants who have no conflict of interest or who agree to an identified mitigation process prior to their participation were involved in the CME activity.

    Stephen Brunton, MD, FAAFP, CDCES, has served on an advisory board and/or speaker’s bureau for Abbott Diabetes Care, AstraZeneca, Bayer, Boehringer Ingelheim, Lilly, Sanofi, and Xeris and has stock options with Paracrine. Stephen Fishbane, MD, has been a consultant and/or researcher for AstraZeneca, Fibrogen, GlaxoSmithKline, and Akebia. Jennifer Goldman, PharmD, has served on an advisory board and/or speaker’s bureau for Novo Nordisk, Lilly, Amarin, Xeris, Sanofi, Abbott Diabetes Care, Boehringer Ingelheim, and Bayer. Eugene Wright, MD, has served as an advisor/consultant and/or speaker for Abbott Diabetes Care, Bayer, Boehringer Ingelheim, Lilly, Sanofi, and GlaxoSmithKline.

    Austin Ulrich, PharmD, provided editorial support and has no disclosures to report.

    Sponsorship

    This activity is sponsored by the Primary Care Metabolic Group and the Primary Care Education Consortium.

    Support

    This activity is supported by an educational grant from GlaxoSmithKline.

    Acknowledgments

    The authors received writing/editorial support in the preparation of video and manuscript content from Austin Ulrich, PharmD, of Primary Care Education Consortium. The content for this article and the associated video series were produced according to the policies of the Accreditation Council for Continuing Medical Education (ACCME). GlaxoSmithKline had no input into the topic, forum discussion, or any content for this article and the accompanying videos.

     

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