To Dialyze or Not to Dialyze? The Great Debate: Use of Renal Replacement Therapy in Patients With Acute Kidney Injury in the Context of Cirrhosis

To Dialyze or Not to Dialyze? The Great Debate: Use of Renal Replacement Therapy in Patients With Acute Kidney Injury in the Context of Cirrhosis is organized by National Kidney Foundation (NKF).

Course Opens: 06/28/2019
Course Expires: 06/28/2020

Available Credit:
• 0.50 AANP and ANCC Pharmacology
• 1.50 ACPE Contact Hours
• 1.50 AMA PRA Category 1 Credit™
• 1.50 ANCC Nurse Contact Hours
• 1.50 ASWB Continuing Education Clock Hours
• 0.50 ANCC Pharmacology
• 1.50 Attendance
• 1.50 Category I Credit for Physician Assistants
• 1.50 CDR CPEUs

Description:
Hepatorenal syndrome/acute kidney injury (HRS/AKI) describes the reversible, functional renal impairment that occurs in patients who have advanced liver cirrhosis, arising portal hypertension, and/or those with fulminant hepatic failure. Most commonly encountered as AKI in patients with decompensated cirrhosis, HRS/AKI is characterized by a reduction in glomerular filtration rate and renal plasma flow, in the absence of other causes of AKI. Prognosis is poor, with high mortality rates, and there are currently no approved pharmacotherapies to ameliorate the effects of HRS/AKI in the US. Should patients be nonresponsive to vasoconstrictor therapy or the severity of liver failure warrant immediate transplantation, the role of the nephrologist is critical in maintaining renal function, including the decision on whether to use renal replacement therapy (RRT). The degree of any benefit of RRT in these patients is currently unclear.

This activity will present the current evidence and positions both for and against the use of RRT in patients with HRS/AKI; participants will be presented with some patient scenarios and challenged to vote on whether they believe RRT would be beneficial in these patients.

Learning Objectives:
After participation in this activity, learners will be better able to:
• Discuss guidelines and evidence for or against the use of renal replacement therapy (RRT) approaches in patients with acute kidney injury (AKI) in the context of decompensated cirrhosis
• Describe the etiology of portal hypertension and other pathologies leading to vasoconstriction of the renal bed and development of hepatorenal syndrome (HRS) 
• Stratify risks and benefits of pharmacologic and surgical options for patients with HRS, and how RRT initiation may be impacted by their use
• Identify patients with HRS who may obtain benefit from short-term RRT, based on etiology and severity