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Breaking the Cycle in Cardiorenal Anemia Syndrome: The Practice-changing Role of IV Iron at the CKD-Heart Failure Interface

  • Authors: Matthew R. Weir, MD (Activity Chair); Javed Butler, MD, MPH, MBA
  • CME Released: 9/29/2022
  • Valid for credit through: 9/29/2023
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

Nephrologists, cardiologists, and primary care physicians who help manage patients with cardiorenal anemia syndrome, including non–dialysis-dependent chronic kidney disease (NDD-CKD), heart failure (HF), or both.

The goal of this activity is for the learners to be better able to determine intravenous (IV) iron safety and efficacy and recognize the need for multidisciplinary care for patients with cardiorenal anemia syndrome.

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

  • Evaluate the fundamental facets of the "pathologic triad" in cardiorenal anemia syndrome (CRAS), with a particular focus on the multifaceted effects of concomitant anemia on CKD and HF disease progression
  • Describe proposed mechanisms of interrelationship between NDD-CKD, HF, and anemia, with a renewed emphasis on the pathophysiologic impact of iron deficiency (ID)
  • Discuss the basic tenets of iron metabolism and absorption in NDD-CKD and HF, including the essential utility of serum ferritin and transferrin saturation (TSAT) as diagnostic laboratory indices for iron deficiency (ID) and iron deficiency anemia (IDA) assessment and treatment decisions
  • Appraise completed, ongoing, and planned clinical trials establishing the safety and efficacy of IV iron therapies for ID/IDA in both NDD-CKD and HF, and identify pivotal data readouts that have influenced current practice and consensus guidelines
  • Investigate the emerging clinical potential of IV iron to safely and effectively treat anemia of CRAS and, thereby, reduce the progression of both NDD-CKD and HF and optimize patient outcomes across the continuum
  • Examine IV iron as a therapeutic adjunct/alternative to erythropoiesis-stimulating agents for patients with CRAS
  • Identify how the innovative nanoparticle design of next-generation IV iron agents dramatically improves upon the safety profiles of older generation products, with anaphylaxis and severe hypersensitivity rates as low as 0.1%
  • Use a real-world, case-based format to analyze how CRAS inflammatory molecular signatures and elevated hepcidin levels impact the comparative clinical utility of oral vs IV iron supplementation modalities for ID/IDA management in NDD-CKD and HF
  • Compare and contrast currently FDA-approved IV iron products, including approved indications and practical clinical differentiators, such as the capacity for total dose infusions
  • Design iron repletion treatment plans for patients with CRAS using innovative, evidence-supported clinical tools, such as diagnostic algorithms, integrated digital checklists, and Ganzoni’s formula

All clinicians managing patients with NDD-CKD or HF must be aware of the deleterious impacts of concomitant anemia and the established, emerging, and practice-changing role of IV iron therapies. The vicious cycle of CRAS -- the pathologic triad wherein the 3 conditions are each capable of causing and/or being caused by the other -- can be effectively mitigated and managed with IV iron. Unfortunately, clinician hesitancy in prescribing IV iron, largely due to adverse effects associated with earlier formulations, must be overcome before the full benefit of IV iron in CRAS can be realized. Join Drs. Matthew Weir and Javed Butler as they address CRAS pathophysiology, examine applicable expert consensus guidelines, and review current evidence for treatment. Practical, case-based elements will be offered that provide learners with real-world examples of IV iron safety, efficacy, and the need for multidisciplinary (nephrologist-cardiologist-PCP) care.


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

It is the policy of Creative Educational Concepts LLC (CEC) to ensure independence, balance, objectivity, and scientific rigor and integrity in all their CME/CE activities. Activity planners, faculty, peer reviewers, and CEC staff must disclose to the participants any relationships with ineligible entities whose products or devices may be mentioned in this CE activity, or with the commercial supporter of this CE activity. An ineligible entity is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Financial relationships may include research grants, consultant fees, travel, advisory boards, consultancy, speakers’ bureaus, other benefits, or having a self-managed equity interest in a company.

CEC has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. CEC, the faculty, and any commercial supporter of this activity do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

Activity Chair

  • Matthew R. Weir, MD

    Director, Division of Nephrology
    Professor of Medicine
    University of Maryland Medical System
    Baltimore, Maryland


    Disclosure: Matthew R. Weir, MD, has the following relevant financial relationships:Advisor or consultant: Akebia; AstraZeneca; Bayer; Boehringer Ingelheim; GlaxoSmithKline; Janssen; Merck; Novo Nordisk; Vifor Pharma

Expert Faculty

  • Javed Butler, MD, MPH, MBA

    President, Baylor Scott & White Research Institute
    Dallas, Texas
    Distinguished Professor of Medicine
    University of Mississippi
    Jackson, Mississippi


    Disclosure: Javed Butler, MD, MPH, MBA, has the following relevant financial relationships:
    Consultant: Abbott; Adrenomed; Amgen; Applied Therapeutics; Array; AstraZeneca; Bayer; Boehringer lngelheim; Bristol Myers Squibb; CVRx; G3 Pharmaceutical; Impulse Dynamic; lnnolife; Janssen; Luitpold; Medtronic; Merck; Novartis; Novo Nordisk; Relypsa; Roche; UvaNova; Vifor
    Speakers bureau: AstraZeneca; Boehringer lngelheim; Janssen; Lilly; Novartis

Matthew R. Weir, MD, has the following relevant financial relationships:
Advisor or consultant: Akebia; AstraZeneca; Bayer; Boehringer Ingelheim; GlaxoSmithKline; Janssen; Merck; Novo Nordisk; Vifor Pharma

Peer Reviewer
Donna S. Hanes, MD, has no relevant financial relationships in relation to the content of this activity.

CEC Staff
Bryan C. Taylor, PharmD, has no relevant financial relationships in relation to the content of this activity.
Jessica Hall has no relevant financial relationships in relation to the content of this activity.

Accreditation Statements

In support of improving patient care, Creative Educational Concepts 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 pro¬vide continuing education for the healthcare team.

    For Physicians

  • CEC designates this live educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Contact This 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 66% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it 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. We encourage you to 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.


Breaking the Cycle in Cardiorenal Anemia Syndrome: The Practice-changing Role of IV Iron at the CKD-Heart Failure Interface

Authors: Matthew R. Weir, MD (Activity Chair); Javed Butler, MD, MPH, MBAFaculty and Disclosures

CME Released: 9/29/2022

Valid for credit through: 9/29/2023


Pre-Assessment Questions

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