Monday, March 27, 2023
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Professor of Medicine
Tufts School of Medicine
Boston, Massachusetts
Nephrology, Renal and Transplant Associates of New England
Springfield, Massachusetts
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
Physicians - maximum of 0.75 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.75 ABIM MOC points
Nurses - 0.75 ANCC Contact Hour(s) (0.5 contact hours are in the area of pharmacology)
IPCE - 0.75 Interprofessional Continuing Education (IPCE) credit
This activity is intended for nephrologists, primary care physicians, nurses, nurse practitioners, and physician assistants.
The goal of this activity is that learners will be better able to improve the quality of life in patients with chronic kidney disease (CKD) on dialysis by improving their competence to screen, diagnose, manage, and educate these patients in a team-based management approach.
Upon completion of this activity, participants will:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
Disclosures for additional planners can be found here.
Professor of Medicine
Tufts School of Medicine
Boston, Massachusetts
Nephrology, Renal and Transplant Associates of New England
Springfield, Massachusetts
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
This activity was planned by and for the healthcare team, and learners will receive 0.75 Interprofessional Continuing Education (IPCE) credit for learning and change.
Medscape, LLC designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.
Awarded 0.75 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.50 contact hours are in the area of pharmacology.
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credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
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CME / ABIM MOC / CE Released: 11/4/2022
Valid for credit through: 11/4/2023
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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Lucas is a 67-year-old man who started hemodialysis (HD) 3 months ago. The nurse notices that despite initiation of dialysis treatment, Lucas still appears groggy and unwell. When asked how he is feeling, he states he hasn’t been sleeping well.
The nurse asks Lucas whether there have been any specific symptoms keeping him awake, he states he has been kept awake by itching. He notes that his skin has been very dry since he started swimming at the local pool in the evenings.
The nurse relays these symptoms to the care team. On your exam, you notice excoriation on the patient’s neck and back and suspect that his itching and lack of sleep might be related to his kidney disease.
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History |
Findings |
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Medical |
History of hypertension Pre-diabetic |
|
Medications |
Lisinopril Amiodipine Atorvastatin Cetirizine (self-administered) |
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Allergies |
Penicillin |
|
Family |
Paternal grandfather (55 years old): deceased, acute cardiac arrest Mother (89 years old): deceased, unspecified natural causes Father (81 years old): deceased, congestive heart failure Brother (69 years old): history of hypertension, previous cardiac arrest
|
|
Psychosocial |
Reports difficulty sleeping |
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Immunizations |
All immunizations are up to date. Patient has received fourth COVID-19 booster |
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Physical Examination |
Findings |
|
Vital signs |
Height: 5’11’’ Weight: 210 lb BMI: 29 BP: 143/100 mmHg Heart rate: 82 bpm |
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General |
Normal |
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Skin |
Widespread xerosis, visible excoriations on neck and back |
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Chest and lungs |
Normal |
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Heart |
Normal |
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Abdomen |
Normal |
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Upper/lower extremities |
Normal |
BMI, body mass index; BP, blood pressure.
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Test |
Result |
Reference Range |
|
CBC with differential/platelet |
||
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White blood cell count |
7000 cells/mcL |
4500 to 10,000 cells/mcL |
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Lymphocytes, absolute
|
2000 cells/mcL |
800 to 5000 cells/mcL (absolute) |
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Monocytes, absolute |
500 cells/mcL |
400 to 1000 cells/mcL (absolute) |
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Granulocytes, absolute |
2500 cells/mcL |
1800 to 8300 cells/mcL (absolute) |
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Neutrophils, absolute |
2000 cells/mcL |
1800 to 8300 cells/mcL (absolute) |
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Eosinophils, absolute
|
400 cells/mcL |
0 to 800 cells/mcL (absolute) |
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Basophils, absolute
|
20 cells/mcL |
0 to 100 cells/mcL (absolute) |
|
Hemoglobin |
10 g/dL |
Male: 13.8 to 17.2 g/dL Female: 12.1 to 15.1 g/dL |
|
Platelet count 230 |
230 thousand/mcL |
150 to 400 thousand/mcL |
|
Creatinine |
||
|
Creatinine |
12 mg/dL |
Male: 0.7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) Female: 0.6 to 1.1 mg/dL (53 to 97.2 µmol/L) |
|
Urine CRP Test |
||
|
CRP |
5 mg/dL |
< 1.0 mg/dL |
|
Renal metrics |
||
|
Kt/V |
1.8 |
1.26 |
|
Urea reduction ratio |
80% |
67% |
CBC, complete blood count; CRP, C-reactive protein.
