Managing CKD-MBD through the Disease Continuum

ASN Renal Week 2008 Official Symposium
Hartmut H. Malluche, MD

Early Management of Phosphate and Vitamin D in CKD
Ravi I. Thadhani, MD

When to Start Phosphate Binder Therapy
Bryan R. Kestenbaum, MD

Audience questions and discussion
(Drs. Thadhani, and Kestenbaum)

Hartmut H. Malluche, MD (Moderator)
Chief, Division of Nephrology
Bone and Mineral Metabolism
Robert G. “Robin” Luke Chair in Nephrology
University of Kentucky, Lexington
Lexington, Kentucky

Ravi I. Thadhani, MD
Associate Professor of Medicine,
Harvard Medical School,
Massachusetts General Hospital

Bryan R. Kestenbaum, MD
Assistant Professor of Medicine,
Division of Nephrology
University of Washington
Harborview Medical Center
Seattle, Washington
This group of talks is accredited for up to 1.5 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: March 12, 2009
CME Credit Eligible Through: April 30, 2010
AMA PRA Category 1 Credits™: 1.5
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.

Mineral and bone disorders (MBD) are an inevitable consequence of chronic kidney disease (CKD). Both hyperphosphatemia and vitamin D deficiency are associated with poor outcomes primarily related to cardiovascular events. This symposium will address clinical issues in the management of CKD-MBD. Observational and clinical trial data demonstrating the link between abnormalities in calcium, phosphorus, and vitamin D in CKD will be reviewed followed by a discussion of the role of early management of these disorders on CKD patient outcomes. Therapeutic issues related to management of hyperphosphatemia and vitamin D deficiency will be reviewed including timing of therapy and choice of therapeutic agents.


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 1.5 AMA PRA Category 1 Credits&trade. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This ASN Official Symposium was supported by an educational grant from Genzyme.

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

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