7:00 a.m.

Registration and Continental Breakfast

8:00 a.m.

Welcome and Opening Remarks

8:15 a.m.

Chronic Kidney Disease (CKD) as a Public Health Crisis
CKD is a growing epidemic in the United States and worldwide. Morbidity and mortality among patients with CKD are high as are costs associated with care, which is highly fragmented. This presentation will address the growing magnitude of CKD incidence, highlight challenges to meeting evidence-based guidelines, and identify strategies used in early detection of this “silent” disease.

Objectives:

1. Review the increased incidence of CKD.
2. Discuss challenges to meeting the evidence-based guidelines for CKD.
3. Identify strategies for early detection of CKD.

9:15 a.m.

Management Strategies for CKD Patients
With 73 million Americans at risk for kidney disease due to diabetes, high blood pressure, or a family history of kidney failure, and more than 415,000 people in the United States dependent on dialysis treatment to survive, a management plan should include careful coordination of care that addresses strategies to promote patient self-management. This presentation will discuss interventions that can enhance adherence through self-management strategies.

Objectives:

1. Discuss interventions that can enhance adherence to promote glycemic control.
2. State the key components of a multifaceted treatment plan for self-management strategies.
3. List modifiable barriers to self-management.
4. Discuss the role of cultural factors that should be considered with self-management.

10:00 a.m.

Break

10:15 a.m.

A New Approach for Evaluating Renal Function and Predicting Risk
Currently, kidney disease severity can be classified by estimated glomerular filtration rate (eGFR) and albuminuria, but more accurate information regarding risk for progression to kidney failure is required for clinical decisions about testing, treatment, and referral. A new international study from the Chronic Kidney Disease Prognosis Consortium found that using cystatin C blood levels to estimate kidney function—alone or in combination with creatinine—strengthens the association between kidney function and risks of death and ESRD. This presentation will discuss improved methods for identifying the subset of patients who are at the highest risk of adverse outcomes and how this could be useful for clinicians and other decision-makers.

Objectives:

1. Evaluate whether combining creatinine, cystatin C, and urine albumin-to-creatinine ratio (ACR) would improve identification of risks associated with CKD compared with creatinine alone.
2. Describe the patient populations that would most benefit from using cystatin C in GFR estimating equations.
3. Review whether cystatin C has the potential to make eGFR more accurate.
4. Discuss the limitations of eGFR alone for predicting the risk of CKD.

11:15 a.m.

Reducing Cardiovascular Risk for Patients With CKD
Over the last decade, the nephrology community has come to recognize the importance of cardiovascular risk for patients with CKD. Early identification and treatment of CKD may impact cardiovascular morbidity and mortality in patients with CKD by reducing risk. This presentation will discuss approaches to reduce risk and prevent cardiovascular events in CKD patients.

Objectives:

1. Discuss how to reduce cardiovascular risk in CKD patients.
2. Review the recommendations for dyslipidemia management for patients with CKD.
3. Discuss the value of cholesterol-lowering therapies in kidney disease.

12:00 p.m.

Luncheon Presentation—An Overview of Optum™ (optional; lunch provided)

1:30 p.m.

Outcomes of Early vs. Late Nephrology Referral in CKD
Timely referral to a nephrologist for the management of CKD is of critical importance—late referral can result in serious consequences. Patients with ESRD experience significant morbidity, including a substantial decline in quality of life. Mortality is high despite improvements in the overall quality of dialysis therapy and increased healthcare expenditures. Patients with CKD are referred to nephrologists either early (usually for help in diagnostic and management issues) or late (referral is usually considered late if patient is referred just before requiring renal replacement therapy) in their clinical course. The late referral of patients with CKD may adversely affect outcomes for dialysis patients, in part due to the suboptimal management of complications associated with kidney failure. This presentation will review the impact of timely referrals to a nephrologist and the initiation of renal replacement therapy in patients with CKD.

Objectives:

1. State potential benefits of timely referral to a nephrologist.
2. Discuss the reasons for and consequences of late referral to a nephrologist.
3. Identify indications and effective strategies for late-referral patients.
4. Review clinical practice guidelines regarding indications for referral of CKD patients to a nephrologist.

2:15 p.m.

Epidemic of Childhood Obesity: Implications for Kidney Disease
Obesity has been recognized as a risk factor for the development and progression of CKD. We have seen the prevalence of ESRD rise dramatically in the past decade in parallel with the increase in obesity. Childhood obesity has become a global epidemic with many long-term adverse effects on morbidity and mortality. This presentation will address childhood obesity as a risk factor for CKD.

Objectives:

1. Discuss the epidemiology of obesity and CKD.
2. State the risk factors of childhood obesity.
3. Describe the impact of childhood obesity and kidney disease.

3:00 p.m.

Break

3:15 p.m.

CKD in Pediatrics: Management Strategies for Long-Term Complications and Transition to Adult Care Settings
CKD is much more common in adults than in children, but the incidence of CKD in children has increased steadily over the past two decades. The treatment of CKD in this age group presents unique challenges. Among those challenges are the management of several comorbid conditions such as anemia, growth and nutrition, bone and mineral disorders, and cardiovascular complications, as well as the transition to adult care settings. This presentation will discuss management strategies for long-term complications in pediatric patients and address the evolving field of “transition medicine” as complex pediatric patients transition to adult care.

Objectives:

1. Discuss management strategies for long-term complications in pediatric patients with kidney disease.
2. Review therapeutic strategies for optimizing nutrition and growth in children with CKD.
3. Identify modifiable risk factors for CKD.
4. Describe “transition medicine” as it relates to complex pediatric patients' transition to the adult care setting.

4:00 p.m.

Palliative Care: ESRD
Palliative care refers to the comprehensive management of the physical, psychological, social, and spiritual needs of the patients and their families in the setting of serious illness. Providing palliative care to patients with CKD begins at diagnosis and continues throughout the patient's life. This presentation will discuss approaches to care planning and various tools that have been used to assess patients' quality of life.

Objectives:

1. Identify patients for whom palliative care is appropriate.
2. Describe approaches to care planning in minority populations.
3. Discuss the importance of collaboration between renal, palliative, and primary care services to ensure a whole systems approach and avoid unnecessary hospital admissions.

5:00–7:00 p.m.

Complimentary Get-Acquainted Reception
Join your colleagues for hors d’oeuvres and beverages. You won’t want to miss this opportunity to gather information and ideas from exhibitors regarding the management of kidney disease and other complex medical conditions.

7:30 a.m.

Continental Breakfast

8:00 a.m.

The Affordable Care Act (ACA) and Its Impact on CKD
Since the passage of the ACA, the kidney community has identified a number of healthcare reform implementation issues that would need to be resolved. This presentation will review how the ACA addresses the many concerns of people with kidney disease as well as transplant recipients and living donors.

Objectives:

1. Identify the impact of the ACA on individuals with CKD and ESRD.
2. Discuss recommended strategies to assist caregivers and providers in implementing the new legislation.

9:00 a.m.

Renal Replacement Therapy (RRT)
With the rising incidence and prevalence of kidney disease in the United States, the need for chronic RRT is a cause for concern. Education is an important aspect of the management of patients starting dialysis, and selecting the right modality for the patient influences well-being, costs, and outcomes. In addition to comparing hemodialysis, peritoneal dialysis, and home-based therapies, this session will discuss how proper preparation and modality selection influence outcomes for patients on dialysis. The effects of the Centers for Medicare & Medicaid Services (CMS) “bundled” payment system for patients with ESRD will also be reviewed.

Objectives:

1. Compare hemodialysis, peritoneal dialysis, and home-based therapies.
2. Discuss predictors of survival for patients receiving dialysis, and review complications of dialysis treatment.
3. Explain the ‘bundled’ payment system for dialysis and its effect on patients with ESRD.

10:00 a.m.

Break

10:15 a.m.

Whatever Happened to Fistula First?
An arteriovenous fistula (AVF) is the optimal vascular access for hemodialysis because it is associated with prolonged survival, fewer infections, lower hospitalization rates, and reduced costs. Timely referral plays an important role in being able to provide a patient with an AVF. Early identification will preserve blood vessels suitable for an AVF, as well as allow the necessary time for the fistula to mature following surgery so that it will be ready for use when needed. This presentation will review the benefits of an AVF as vascular access for hemodialysis, identify barriers for placing vascular access in dialysis patients, and discuss the Fistula First Breakthrough Initiative (FFBI).

Objectives:

1. State the benefits of an AVF as vascular access for hemodialysis.
2. Discuss the role of the FFBI.
3. Identify barriers for placing vascular access in dialysis patients.

11:15 a.m.

Preemptive Kidney Transplantation: Financial and Clinical Benefits
Preemptive treatment uses transplantation as the primary renal replacement therapy in the absence of any preceding dialysis. This therapy maximizes the chance of maintaining a high quality of life and may avoid the morbidity of dialysis as well as the associated financial costs. This presentation will address the financial and clinical benefits of preemptive renal transplantation and its impact on the quality of life for the CKD patient.

Objectives:

1. State the optimal timing of preemptive transplantation.
2. Discuss the benefits of preemptive transplantation over transplantation after dialysis.
3. Identify barriers to preemptive transplantation.

12:00 p.m.

Lunch (provided)

1:00 p.m.

Renal Transplantation: Expanding the Donor Pool Through Kidney Paired Donation (KPD)
Today, more than 80,000 people are waiting for a kidney transplant and approximately 4500 will die while waiting for a kidney transplant in the United States. The KPD Program was launched as a pilot program several years ago. This special type of kidney transplant exists for patients who have a willing but incompatible donor and has increased transplant options for patients on the kidney transplant list. This presentation will review the impact of the KPD program on patients in need of a transplant and address barriers to implementing kidney paired donation.

Objectives:

1. Discuss how to expand the donor pool through kidney paired donation.
2. State potential barriers to implementing kidney paired donation.

2:00–3:00 p.m.

Ethical and Cultural Considerations in CKD
When caring for patients with CKD, numerous ethical issues such as the appropriate initiation or withdrawal of dialysis are inherent. Conflicts concerning decisions to withhold or withdraw dialysis often involve particularly vulnerable CKD patients such as the elderly, those with cognitive impairment, or those who come from different cultural backgrounds. This presentation will debate such considerations.

Objective:

1. State ethical issues and key cultural considerations surrounding patients with CKD, patients on dialysis, and patients who are transplanted.