The ESA Controversy: The Role of Intravenous Iron

ASN Renal Week 2008 Official Symposium
Introduction
Adeera Levin, MD

Molecular Control of Iron Transport
Tomas Ganz, MD, PhD

Continuous IV Iron Therapy in the Management of ESRD-Associated Anemia
Rajiv Agarwal, MD, MBBS, FASN

An Integrated Approach to Anemia Management in ESRD Patients
Anatole Besarab, MD, FACP

Audience questions and discussion
 (Drs. Ganz, Agarwal, and Besarab)




Adeera Levin, MD, FRCPC (Moderator)
St. Paul's Hospital and University of British Columbia
Vancouver, BC, Canada

Tomas Ganz, MD, PhD
Professor of Medicine and Pathology,
Department of Medicine,
David Geffen School of Medicine at UCLA,
Los Angeles, CA, USA

Rajiv Agarwal, MD, MBBS, FASN
Associate Professor of Clinical Medicine at Indiana University and Richard L. Roudebush Veterans Administration Medical Center,
Indianapolis, Indiana

Anatole Besarab, MD, FACP
Director of Clinical Research,
Division of Nephrology and Hypertension,
Henry Ford Hospital,
Detroit, MI




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: January 14, 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.

OVERVIEW :
Iron has become an important and commonly used therapy in the management of anemia associated with end-stage renal disease. Appropriate use of IV iron is perhaps even more critical now, given new limitations and guidelines associated with the use of ESAs. Benefits of iron include the correction of iron deficiency and potentiation of the therapeutic response to erythropoietic stimulating agents (ESA). However, concerns have been raised about potential adverse effects of iron. The purpose of this symposium is to address issues related to the use of iron in the management of anemic CKD patients. The molecular control of iron transport will first be reviewed focusing on the role of hepcidin and ferroportin on iron homeostasis. Issues regarding the use of iron in CKD patients will then be discussed. The final talk of this symposium will provide an integrated approach to anemia management that includes the systems that need to be in place for optimal management of anemia and therapeutic considerations in the use of IV iron and ESAs.

ACCREDITATION AND DESIGNATION STATEMENTS:

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.

SPONSORSHIP / SUPPORT :
This ASN Official Symposium was supported by an education grant from Watson Nephrology.

FACULTY DISCLOSURE STATEMENTS :
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.

DISCLOSURE OF UNLABELED USE:
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.
DISCLAIMER:
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.

USER INSTRUCTIONS:
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 www.microsoft.com) or the Flash version 8.0 (download from www.adobe.com) 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 www.adobe.com.

For any questions concerning this specific activity please send an email to or email@asn-online.org, 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.