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CME / ABIM MOC / CE

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
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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


Disclosures

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.


Faculty

  • Michael J. Germain, MD

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

    Disclosures

    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

Editor

  • Cheryl Perkins, MD, RPh

    Medical Education Director, Medscape, LLC

    Disclosures

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

  • Ashley Stumvoll, MRes

    Associate Medical Writer, Medscape, LLC

    Disclosures

    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

    Disclosures

    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



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.

    Contact This Provider

    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.

    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 70% 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.

CME / ABIM MOC / CE

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

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References

  1. Sukul N, et al. Pruritus and patient reported outcomes in non-dialysis CKD. Clin J Am Soc Nephrol. 2019;14:673-681. 
  2. Weisbord SD, et al. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007;2:960-967. 
  3. Rayner HC, et al. International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol. 2017;12:2000-2007. 
  4. Świerczyńska K, et al. Chronic intractable pruritus in chronic kidney disease patients: prevalence, impact, and management challenges -- a narrative review. Ther Clin Risk Manag. 2021;17:1267-1282. 
  5. Pisoni RL, et al. Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006;21:3495-505.  
  6. Verduzco HA, et al. Chronic kidney disease-associated pruritus: new insights into diagnosis, pathogenesis and management. Kidney Int Reports. 2020;5:1387-1402. 
  7. Cheng AY, et al. Uremic pruritus: from diagnosis to treatment. Diagnostics. 2022;12:1108. 
  8. Yosipovitch G, et al. Chronic pruritus. N Engl J Med. 2013;368:1625-1634. 
  9. Mettang T, et al. Uremic pruritus. Kidney Int. 2015;87:685-691. 
  10. Kuypers, DR. Skin problems in chronic kidney disease. Nat Clin Pract Nephrol. 2009;5:157-170. 
  11. Patel TS, et al. An update on pruritus associated with CKD. Am J Kidney Dis. 2007;50:11-20.
  12. Shirazian S, et al. Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges. Int J Nephrol Renovascular Dis. 2017; 10:11-26. 
  13. Wang H, et al. New insights into the pathophysiology and treatment of chronic itch in patients with end-stage renal disease, chronic liver disease, and lymphoma. Int J Dermatol. 2010;49:1-11.
  14. Kimmel M, et al. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transpl. 2006;21:749-755.
  15. Wang CCY, et al. Pruritus in chronic kidney disease: an update. Allerg. 2022;2:87-105. 
  16. Shirazian S, et al. Longitudinal predictors of uremic pruritus. J Renal Nutr. 2013;23:428-431. 
  17. Gatmiri SM, et al. Uremic pruritus and serum phosphorus level. Acta Med Iran. 2013;51:477-81. 
  18. Satoh T, et al. 2020 guidelines for the diagnosis and treatment of cutaneous pruritus. J Dermatology. 2021;48:e399-e413. 
  19. Pereira MP, et al. Assessment of severity and burden of pruritus. Allergol Int. 2017;66:3-7. 
  20. Carmichael P, et al. Assessment of quality of life in a single centre dialysis population using the KDQOL-SFT questionnaire. Qual Life Res. 2000;9:195-205. 
  21. Ramakrishnan K, et al. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms. Int J Nephrol Renovascular Dis. 2013;7:1-12. 
  22. Hercz D, et al. Interventions for itch in people with advanced chronic kidney disease. Cochrane Db Syst Rev. 2020;12:CD011393. 
  23. Nofal E, et al. Gabapentin: a promising therapy for uremic pruritus in hemodialysis patients: a randomized-controlled trial and review of literature. J Dermatol Treat. 2016;27:1-5. 
  24. Eusebio-Alpapara KMV, et al. Gabapentin for uremic pruritus: a systematic review of randomized controlled trials. Int J Dermatol. 2020;59:412-422.
  25. Raouf M, et al. Rational dosing of gabapentin and pregabalin in chronic kidney disease. J Pain Res. 2017;10:275-278.
  26. Mathur VS, et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:1410-1419. 
  27. Fishbane S, et al. Randomized controlled trial of difelikefalin for chronic pruritus in hemodialysis patients. Kidney Int Rep. 2020;5:600-610. 
  28. Wooldridge TD, et al. Efficacy and safety of difelikefalin for moderate-to-severe CKD–associated pruritus: a global phase 3 study in hemodialysis patients (KALM-2). Presented at: ASN Kidney Week Virtual; October 20-25, 2020. Abstract FR-OR24.
  29. Topf J, et al. Efficacy of difelikefalin for the treatment of moderate-to-severe pruritus in hemodialysis patients: pooled analysis of KALM-1 and KALM-2 phase 3 studies. Kidney Med. 2022;4:100512.
  30. Fishbane S, et al. Randomized controlled trial of difelikefalin for chronic pruritus in hemodialysis patients. Kidney Int Reports. 2020;5:600-610.
  31. Narita I, et al. Efficacy and safety of difelikefalin in Japanese patients with moderate to severe pruritus receiving hemodialysis. JAMA Netw Open. 2022;5:e2210339. 
  32. Korsuva [prescribing information]. Approved 2021. Revised August 2021.
  33. Kumagai, H et al. Effect of a novel kappa-receptor agonist, nalfurafine hydrochloride, on severe itch in 337 haemodialysis patients: a phase III, randomized, double-blind, placebo-controlled study. Nephrol Dial Transpl. 2009;25:1251-1257. 
  34. Mathur VS, et al. A multicenter, randomized, double-blind, placebo-controlled trial of nalbuphine ER tablets for uremic pruritus. Am J Nephrol. 2017;46:450-458. 
  35. Nalbuphine hydrochloride [prescribing information] 2005. Accessed September 12, 2022. www.accessdata.fda.gov/drugsatfda_docs/label/2005/018024s040lbl.pdf
  36. Tubog TD, et al. Use of nalbuphine for treatment of neuraxial opioid-induced pruritus: a systematic review and meta-analysis. AANA J. 2019;87:222-230.
  37. Shram MJ, et al. Evaluation of the abuse potential of difelikefalin, a selective kappa-opioid receptor agonist, in recreational polydrug users. Clin Transl Sci. 2022;15:535-547. 
  38. Sapam R, et al. Role of narrow band ultraviolet radiation as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus. World J Nephrol. 2018;7:84-89.
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