You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.


Clinical Insights Into Nonsteroidal MRAs for CKD in T2D: Examining Evidence & Experience Through a Real-world Case Challenge

  • Authors: Rajiv Agarwal, MBBS, MD, MS, FASN (Moderator); George L. Bakris, MD, HonD, FASN, FAHA; Janet B. McGill, MD, MA, FACE; Robert D. Toto, MD; Muthiah Vaduganathan, MD, MPH
  • CME / CE Released: 6/1/2022
  • Valid for credit through: 10/1/2023, 11:59 PM EST
Start Activity

Target Audience and Goal Statement

This activity is designed for the education of nephrologists, primary care physicians, cardiologists, endocrinologists/diabetologists, physician assistants/nurse practitioners, nurse specialists

To increase knowledge and build confidence in managing patients with chronic kidney disease (CKD) and to better evaluate the potential of recently available agents in the armamentarium for CKD, clinicians need a critical appraisal of the clinical data and a determination of sources of variability in order to assess the robustness of results that may translate into the potential for improved efficacy and safety into clinical practice. Furthermore, to consider incorporating novel agents in diabetic kidney disease (DKD), clinicians need a better understanding of strategies to monitor, dose adjust, and mitigate AEs. Moreover, clinicians need to remain up-to-date with current treatment guidelines, as well as evidence-based strategies to slow disease progression. These strategies may include recent therapies or expanded indications, medication monitoring and safety advice, and identifying treatment of CKD complications. Finally, clinicians need to recognize that the therapeutic overlap in treating DKD patients requires a collaborative approach to improving cardiorenal outcomes.

Upon completion of this activity, participants will be able to:

  1. Assess recent clinical studies supporting nonsteroidal mineralocorticoid receptor antagonists (MRAs) in patients with chronic kidney disease (CKD) in type 2 diabetes (T2D)
  2. Analyze comparative studies to discern differences and similarities to make informed clinical decisions about place in therapy of novel agents
  3. Identify clinical variables (i.e., patient selection) and safety considerations (i.e., dosing initiation, rigorous monitoring) that need to be considered to achieve optimal therapeutic outcomes with nonsteroidal MRAs
  4. Examine strategies to maximize treatment tolerability and manage hyperkalemia in diabetic kidney disease (DKD)
  5. Apply clinical knowledge to problem solving and formulating management strategies of T2D along the disease continuum to minimize risk of developing CKD


CME/CE Provider Disclosure Statement (COI resolution, Off Label, Disclaimers)

Faculty Information and Disclosure Statements

Faculty Affiliation and Disclosures

Disclosures: It is the policy of Letters & Sciences and the Postgraduate Institute of Medicine to ensure balance, independence, and scientific rigor in all educational activities/programs. Those who may have the opportunity to influence content of this CME/CNE program (e.g. planners, faculty, authors, reviewers, and others) must disclose all relevant, significant financial relationships with ineligible companies so that the providers may identify and resolve any conflicts of interest prior to the program. Any relevant financial relationships have been mitigated. No relevant financial relationships were identified for any other individuals with the ability to control content of the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of product(s), device(s) or clinical strategies to the participants at the time of the presentations.

Off-label: The audience is advised that one or more sections in this continuing education activity may contain references to devices and/or protocols or clinical strategies that are unlabeled, investigational, or unapproved by the FDA. Healthcare professionals should note that the use of information presented that is outside of current approved labeling is considered experimental and are advised to consult current prescribing information. The faculty is required to disclose on-site any unlabeled, investigational, and/or unapproved uses or therapies that are to be discussed.

Rajiv Agarwal, MBBS, MD, MS, FASN (Moderator) 

Indiana University School of Medicine

Serves as an advisor or consultant for: AstraZeneca, Ironwood Pharmaceuticals, Akebia, Bayer, Janssen, GlaxoSmithKline, Relypsa, Sanofi and Genzyme US Companies, Boehringer Ingelheim, BirdRock Bio, Celgene, Daiichi Sankyo, Eli Lilly, Reata, Takeda Pharmaceuticals USA, Chinook, ZS Pharma

George L. Bakris, MD, HonD, FASN, FAHA

University of Chicago Medicine

Serves as an advisor or consultant for: Merck, Bayer, Vascular Dynamics, BP Biosciences, Ionis, Alnylam, AstraZeneca, Quantum Genomics, Horizon, Novo Nordisk, Vifor

Janet B. McGill, MD, MA, FACE

Washington University in St. Louis

Serves as an advisor or consultant for: Bayer, Boehringer Ingelheim, Dexcom, Gilead, Mannkind, PreventionBio

Receives grants for clinical research support from: National Institutes of Health, Medtronic, Novo Nordisk, Beta Bionics (former)

Robert D. Toto, MD

University of Texas Southwestern

Serves as an advisor or consultant for: Amgen, Akebia, AstraZeneca, Bayer, Boehringer Ingelheim, Chinook Pharma, Otsuka, Reata, Vifor

Muthiah Vaduganathan, MD, MPH

Harvard Medical School/Brigham and Women’s Hospital

Serves as an advisor or consultant for: American Regent, Amen, AstraZeneca, Bayer AG, Baxter healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Novartis, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi

Served as a speaker or a member of a speakers bureau for: Novartis, Roche Diagnostics

Receives grants for clinical research support from: Amgen (former), AstraZeneca, Bayer AG, Boehringer Ingelheim, Galmed, Impulse Dynamics, Novartis, Occlutech, Roche Diagnostics

Additional Planners/Reviewers Information and Disclosure Statements

Executive Committee, CNE Committee, Planning Committee, Curriculum Committee Members

Content managers/members of the CME, CNE, planning, executive and curriculum committees, of Letters & Sciences and the Postgraduate Institute for Medicine, report no relationships with ineligible companies to disclose.

COI Resolution:

In accordance with the ACCME and ANCC standards to identify and resolve any potential conflicts of interest, to assure fair balance, independence and objectivity, and to instill scientific rigor in all activities/programs, all presentations, with any potential for conflict of interest, have been reviewed by two external reviewers. These external reviewers, who have no potential conflicts of interest, have determined that no bias exists in these presentations.

Michele Nichols, PharmD (External Content Reviewer)

Has no commercial/financial relationships to disclose.

Victoria Rosal-Greif, RN, MA (External Content Reviewer)

Has no commercial/financial relationships to disclose.


  • Rajiv Agarwal, MBBS, MD, MS, FASN (Moderator)

    Professor of Medicine
    Indiana University School of Medicine
    Nephrology Specialist
    Richard Roudebush VA Medical Center
    Indianapolis, Indiana

  • George L. Bakris, MD, HonD, FASN, FAHA

    Professor of Medicine
    Director, American Heart Association Comprehensive Hypertension Center
    University of Chicago Medicine
    Chicago, Illinois

  • Janet B. McGill, MD, MA, FACE

    Professor of Medicine, Division of Endocrinology, Metabolism and Lipid Research
    Center for Advanced Medicine
    Washington University in Saint Louis
    St. Louis, Missouri

  • Robert D. Toto, MD

    Mary M Conroy Professor of Kidney Disease
    UT Southwestern Department of Internal Medicine
    Associate Dean Translational Science and Education
    Director, Center for Translational Medicine
    Principal Investigator, UT Southwestern CTSA Program
    Dallas, Texas

  • Muthiah Vaduganathan, MD, MPH

    Instructor of Medicine
    Harvard Medical School
    Consultant Cardiologist
    Center for Advanced Heart Disease
    Brigham and Women’s Hospital
    Boston, Massachusetts

Accreditation Statements

Letters and Sciences


Interprofessional Continuing Education

In support of improving patient care, Postgraduate Institute for Medicine (PIM) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. PIM is one of a very select group of CME/CE providers that has been awarded the highest level of a 6-year term, placing PIM among the top echelon of CME/CE providers that have demonstrated the highest levels of educational acumen in providing healthcare professionals with relevant, effective, practice-based continuing education that supports US healthcare quality improvement.

    For Physicians

  • The Postgraduate Institute for Medicine designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Contact This Provider

    For Nurses

  • Letters & Sciences is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

    This activity has been designated for 1.5 contact hours. 

    Contact Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 80% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. In addition, you must complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


Clinical Insights Into Nonsteroidal MRAs for CKD in T2D: Examining Evidence & Experience Through a Real-world Case Challenge

Authors: Rajiv Agarwal, MBBS, MD, MS, FASN (Moderator); George L. Bakris, MD, HonD, FASN, FAHA; Janet B. McGill, MD, MA, FACE; Robert D. Toto, MD; Muthiah Vaduganathan, MD, MPHFaculty and Disclosures

CME / CE Released: 6/1/2022

Valid for credit through: 10/1/2023, 11:59 PM EST


Pre-Assessment Questions

Before you begin, please answer the questions in this brief questionnaire.

  • Print