Part 4. Sodium and Volume Control

ISHD Hemodialysis University™
Chicago, IL. September 14/15, 2012

HDCN free zone registration is required.

Dialysate Sodium
Peter Kotanko, MD
Sodium and Volume control
Madhukar Misra MD
Questions and Answers
Drs. Kotanko, and Misra
Determination of Dry Weight
Peter Kotanko, MD
Intradialytic Hypertension
Madhukar Misra MD
Hemodialysis Hypotension
John T. Daugirdas, MD
Questions and Answers
Drs. Daugirdas, and Kotanko

Peter Kotanko, MD
Research Director
Renal Research Institute
New York.

Madhukar Misra MD
Professor of Medicine
University of Missouri Columbia
School of Medicine. Columbia, MO

John T. Daugirdas, MD
Clinical Professor of Medicine
University of Illinois College of Medicine
Chicago, IL
Physicians click on the blue CME button to obtain CME credit.

Nurses and dialysis technicians, please click on the yellow CE button to obtain CE contact hours.
This educational activity is an audio recording with accompanying slides of a live presentation held September 14,15, 2012, in Chicago, IL. Continuing medical education credit will be awarded to physicians who successfully complete this activity with a score of 75% or better on the post-test and return an evaluation. Participation should take approximately 3.0 hours. The same number of continuing education contact hours will be awarded to nurses and dialysis technicians who fulfill these guidelines.

To complete this activity and receive credit, the participant should listen to the talks, scroll down to review the accompanying slides, review the PubMed abstracts of the linked slides and references, complete the post-test and evaluation, and read the abstracts linked to the post-test feedback section.

Release Date: July 15, 2013
Review/Approval Date: July 13, 2013
Expiration Date: May 1, 2014
AMA PRA Category 1 Credits™: 3.0
CEU Contact hours: 3.0

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 is required and either can be downloaded for free per instructions on the individual lecture pages. Flash 8.0 (from is useful but not necessary to see the full-screen slide/audio presentations and the video presentations. Acrobat Reader is required to print the CME certificate, and this can be download free from

For questions regarding CME credit or CEU contact hours, the post-test, or evaluation, please call Medical Education Resources at (303)798-9682 or e-mail
The live program on which this Web-based educational activity is based was supported by educational grants from Fresenius Medical Care, Dialysis Centers Inc, Baxter Healthcare, and Amgen. No industry funding was provided for support of the Web-based program.

Program Overview
This program will provide an overview of the various techniques of initiating, managing, and survelling vascular access in hemodialysis patients.

Educational Objectives
Upon completion of this activity, the participants should be able to:
  • Describe how dialysate sodium affects patient weight gain and outcome
  • Describe causes and treatment of interdialytic hypertension
  • Describe risk factors and treaetment of dialysis hypotension
  • Review the role of residual kidney function on patient outcome
Target Audience
This program is intended for endocrinologists, nephrologists, general internal medicine, and other physicians and health care providers who treat patients with diabetes and kidney disease, including nephrology nurses and dialysis technicians.


Physician Credit
Medical Education Resources is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
Medical Education Resources designates each enduring material for a maximum of 3.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Credit
Medical Education Resources is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Each CE activity provides 3 contact hours of continuing nursing education.
Medical Education Resources is approved by the California Board of Registered Nursing, Provider #CEP 12299. This CE activity provides 3 contact hours of continuing nursing education.

Disclosure Policy
It is the policy of Medical Education Resources that participants in CME or CEU activities should be made aware of any affiliation of financial interest that may affect the speaker's presentation(s). Each speaker has completed and signed a conflict of interest statement. The faculty members' relationship will be disclosed in the course materials.

John Daugirdas MD discloses no conflicts of interest.

Peter Kotanko, MD discloses that he is an employee of Renal Research Institute and stockholder in Fresenius Medical Care.

Madhukar Misra, MD discloses no conflicts of interest.

Medical Education Resources staff involved in the development of this activity have no financial relationships relevant to the content of this activity.

Off-label/lnvestigational Use
Because this course is meant to educate physicians with what is currently in use and what may be available in the future, there may be "off-label" use discussed in the presentations. Speakers have been requested to inform the audience when off-label use is being discussed.

Dr. Daugirdas discusses off-label use of midodrine and sertraline for dialysis hypotension treatment.

Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program. The information presented at this CME / CEU program represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, Medical Education Resources. Each participant must use his/her personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses. Before prescribing any medicine, primary references and full prescribing information should be consulted.

Medical Education Resources Policy
Medical Education Resources is committed to on-line privacy and confidentiality. This website is managed by HDCN, and their printed privacy policy applies to this site. CME credit for "ISHD Hemodialysis University 2012-2013: Section 4. Blood Pressure and Volume Control" is provided by Medical Education Resources. If you register for CME credit or CE contact hours for this educational activity, HDCN will forward relevant personally identifiable information to Medical Education Resources so that we can maintain records concerning credits we issue to you. We may share aggregated data concerning registrations, post-tests, and evaluations on request of our commercial supporter. We will not share any personally identifiable information.

To obtain information on other Medical Education Resource programs, you can access their home page at

The CME policy statements of HDCN are listed on this page.