The management of chronic kidney disease-mineral bone disorder (CKD-MBD) is central to the care of patients with kidney disease. Key to these efforts is the availability of clinically accessible biomarkers that can help distinguish between a wide variety of bone and mineral disturbances related to kidney failure. Two such markers, parathyroid hormone (PTH) and alkaline phosphatase, are already well-established in current guidelines for managing CKD-MBD and are familiar to most clinical practitioners. Despite their familiarity, however, there remains considerable uncertainty regarding the optimal use of these biomarkers to guide therapy, particularly with respect to the levels of PTH that should be targeted in each stage of CKD. With the recent discovery of fibroblast growth factor 23 (FGF-23), a novel biomarker has emerged that may ultimately help to clarify some of this uncertainty, especially in regard to the management of disordered phosphorus metabolism in CKD.
After taking part in this educational activity, participants should be better able to:
- Recognize the limitations of measuring parathyroid hormone levels in patients with chronic kidney disease.
- Recognize the role of alkaline phosphatase measurements in clinical practice.
- Identify the emerging roles that fibroblast growth factor 23 has in regulating phosphorus and vitamin D metabolism.
AMA PRA Category 1 Credit(s)TM
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Medical Education Resources (MER) and Haymarket Media, Inc. MER is accredited by the ACCME to provide continuing medical education for physicians.
Medical Education Resources designates this educational activity for a maximum of 1.0 AMA PRA Category 1 creditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Orlando M. Gutiérrez, MD, MMSc
Assistant Professor, Nephrology
Department of Medicine
University of Alabama, Birmingham
Disclosure of Conflicts of Interest:
Medical Education Resources insures balance, independence, objectivity, and scientific rigor in all our educational programs. In accordance with this policy, MER identifies conflicts of interest with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Conflicts are resolved by MER to ensure all scientific research referred to, reported, or used in a CME activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing its learners with high-quality CME activities that promote improvements or quality in health care and not the business interest of a commercial interest.
Orlando M. Gutiérrez, MD, MMSc has indicated no relationships to disclose relating to the content of this article.
Publishing Staff Disclosures:
Jody A. Charnow and Marina Galanakis, Haymarket Media Group, have nothing to disclose with regard to commercial support.
Victoria Smith, MD, Medical Education Resources, Inc., has nothing to disclose with regard to commercial support.
Disclosure of Unlabeled Use:
This educational activity may contain discussion of approved and/or investigational uses of agents that are not indicated by the FDA. Medical Education Resources, Inc. (MER), and Haymarket Medical Education (HME) do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of MER and HME. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources or Haymarket Media, Inc. The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Medical Education Resources, or Haymarket Media, Inc. Before prescribing any medicine, primary references and full prescribing information should be consulted. 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. The information presented in this activity is not meant to serve as a guideline for patient management.
This program is sponsored by Medical Education Resources, Inc.
This program is produced by Haymarket Medical Education.
If you have any questions relating to the accreditation of this activity, please contact:
Medical Education Resources, Inc.
1500 West Canal Court
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To obtain credit, a score of 70% or better is required. This CME is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the posttest survey, and have received your digital copy of your credit certificate. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.
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