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Improving Quality of Life in Patients With Chronic Kidney Disease on Dialysis

  • Authors: Michael J. Germain, MD
  • CME / ABIM MOC / CE Released: 11/4/2022
  • Valid for credit through: 11/4/2023, 11:59 PM EST
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  • Credits Available

    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

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

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:

  • Have greater competence related to
    • Screening for and diagnosing dialysis-dependent CKD-associated pruritus (DD-CKD-aP)
    • Managing DD-CKD-aP
    • Providing patient education related to DD-CKD-aP
  • Have greater confidence in their ability to
    • Provide team-based education of patients related to DD-CKD-aP


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.


  • Michael J. Germain, MD

    Professor of Medicine
    Tufts School of Medicine
    Boston, Massachusetts
    Nephrology, Renal and Transplant Associates of New England
    Springfield, Massachusetts


    Michael J. Germain, MD, has the following relevant financial relationships:
    Consultant or advisor for: Bristol Myers Squibb; ChemoCentryx
    Speaker or member of speakers bureau for: AstraZeneca; Aurinia Horizon; Bristol Myers Squibb; Vifor Pharma
    Research funding from: Bayer, Cara Therapeutics, Trevere Therapeutics


  • Cheryl Perkins, MD, RPh

    Medical Education Director, Medscape, LLC


    Cheryl Perkins, MD, RPh, has no relevant financial relationships.

  • Ashley Stumvoll, MRes

    Associate Medical Writer, Medscape, LLC


    Ashley Stumvoll, MRes, has no relevant financial relationships.

Compliance Reviewer/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements


Interprofessional Continuing Education

In support of improving patient care, Medscape, LLC is jointly accredited with commendation 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.


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.

    For Physicians

  • 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.

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    For Nurses

  • 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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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 70% on the post-test.

Follow these steps to earn CME/CE credit*:

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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.

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Improving Quality of Life in Patients With Chronic Kidney Disease on Dialysis

Authors: Michael J. Germain, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 11/4/2022

Valid for credit through: 11/4/2023, 11:59 PM EST


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.

Case 1: Lucas (67)

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.


Table 1. Patient History




History of hypertension






 Cetirizine (self-administered)




 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



Reports difficulty sleeping


All immunizations are up to date. Patient has received fourth COVID-19 booster


Table 2. Physical Examination

Physical Examination 


Vital signs 

Height: 5’11’’

Weight: 210 lb

BMI: 29 

BP: 143/100 mmHg

Heart rate: 82 bpm




Widespread xerosis, visible excoriations on neck and back

Chest and lungs 






Upper/lower extremities 


BMI, body mass index; BP, blood pressure.

Table 3. Relevant Recent Lab Work



 Reference Range

 CBC with differential/platelet 

 White blood cell count  

 7000 cells/mcL 

 4500 to 10,000 cells/mcL 

 Lymphocytes, absolute


 2000 cells/mcL

 800 to 5000 cells/mcL (absolute) 

 Monocytes, absolute

 500 cells/mcL

 400 to 1000 cells/mcL (absolute) 

 Granulocytes, absolute

 2500 cells/mcL

 1800 to 8300 cells/mcL (absolute) 

 Neutrophils, absolute

 2000 cells/mcL

 1800 to 8300 cells/mcL (absolute) 

 Eosinophils, absolute


 400 cells/mcL

 0 to 800 cells/mcL (absolute) 

 Basophils, absolute


 20 cells/mcL

 0 to 100 cells/mcL (absolute) 


 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 



 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 


 5 mg/dL 

< 1.0 mg/dL 

Renal metrics




 Urea reduction ratio



CBC, complete blood count; CRP, C-reactive protein.
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