Medical Crossfire: Managing Phosphorus in CKD—The Challenge Remains

ASN Renal Week 2007 Official Symposium
A. Introduction
David Bushinsky, MD (moderator)
B. Vascular calcification
David Bushinsky, MD (moderator); Geoffrey Block, MD, CCRI; Francisco Llach, MD; Rajnish Mehrotra, MD
C. Target Serum Phosphate Level
David Bushinsky, MD (moderator); Geoffrey Block, MD, CCRI; Francisco Llach, MD; Rajnish Mehrotra, MD
D. Matching Phosphate Binders to Patients
David Bushinsky, MD (moderator); Geoffrey Block, MD, CCRI; Francisco Llach, MD; Rajnish Mehrotra, MD
E. Phosphorus Control in Predialysis Patients
David Bushinsky, MD (moderator); Geoffrey Block, MD, CCRI; Francisco Llach, MD; Rajnish Mehrotra, MD
F. Audience Questions and Key Take-Home Points
David Bushinsky, MD (moderator); Geoffrey Block, MD, CCRI; Francisco Llach, MD; Rajnish Mehrotra, MD

David Bushinsky, MD (moderator)
University of Rochester Medical Center
Rochester, NY
Geoffrey Block, MD, CCRI
Denver Nephrology
Denver, CO
Francisco Llach, MD
Georgetown University Hospital
Washington, DC
Rajnish Mehrotra, MD, FACP, FASN
Harbor-UCLA Research and Education Institute
Torrance, CA
This group of talks is accredited for up to 2.0 AMA PRA Category 1 credits™. This group of talks has a single post-test, which must be completed along with an evaluation form to obtain credit. The links to the post-test appear on the individual talk pages.
Date of Web Release: February 28, 2008
CME Credit Eligible Through: April 30, 2009
AMA PRA Category 1 Credits™: 2.0
Target Audiences: Physicians, researchers and trainees.
Method of participation: Listen to the talk, read the PubMed abstracts linked to data slides and talk references, take the post-test, read the abstracts linked to post-test answer feedback material.

Through debate and authoritative peer exchange, this Medical Crossfire™ activity will provide a forum to discuss the management of mineral metabolism, with a focus on managing phosphate, in chronic kidney disease (CKD). Elevated serum phosphate remains a clinical challenge in patients with end-stage renal disease. Despite advanced technology and effective dialysis treatment, up to 90% to 95% of dialysis patients are affected. It is estimated that only half of patients who receive treatment achieve the serum phosphate levels set in the current KDOQI guidelines. This symposium will compare and contrast the relative efficacy of varoius classes of phosphate binders and will review current clinical trial and safety data associated with newer non-calcium containing phosphate binders with respect to serum phosphate.


Accreditation Statement
The American Society of Nephrology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME Credit Designation Statement:
The American Society of Nephrology designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This official ASN symposium was supported by a restricted educational grant from Shire Pharmaceuticals Inc.

In accordance with the disclosure policies of the Accreditation Council for Continuing Medical Education (ACCME) and FDA guidelines, it is a policy at the ASN for individuals who are in a position to control the content of an educational activity to disclose to the activity participants: 1) the existence of all relevant financial relationships with any commercial interests or other relationships with the manufacturers of any commercial products/devices, or providers of commercial services, that relate to the content of their presentation/materials, or the commercial contributors of this activity, that could be perceived as a real or apparent conflict of interest; for this purpose we consider relationships of the person involved in the CME activity to include financial relationships of a spouse or partner and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.

Based on the disclosures provided, the ASN is responsible for identifying and resolving all conflicts of interest prior to presenting the educational activity to the learner. The intent of this policy is not to prevent expert faculty with relevant relationship(s) with commercial interest(s) from involvement in CME, but rather to ensure that ASN CME activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of control from commercial interests and free of commercial bias. In addition, all faculty members were instructed to provide balanced, scientifically rigorous, and evidence-based presentations. (Faculty Disclosure Statement should

Faculty disclosures are posted on each individual talk page.

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by FDA. The American Society of Nephrology and HDCN do not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. Faculty disclosure about unlabeled or off-label use is posted on each individual talk page.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

To complete this educational activity, the user will need Windows (XP or higher) or Macintosh (version 9.0 or higher) operating software, a connection to the internet with a 28.8 kbps MODEM or better. The computer should have an audio card with speakers. An audio player, either the Windows Media Player (download from or the Flash version 8.0 (download from is required, and either can be downloaded for free per instructions on the individual lecture pages. Flash version 8.0 is required for the full-screen slide version of the program. Acrobat Reader is required to print the CME certificate, and this can be download free from

For any questions concerning this specific activity please send an email to or, or call HDCN at 630-325-3276 during normal business hours, Chicago time (Central Standard Time).

For any general questions concerning ASN CME, please contact the American Society of Nephrology.