Einstein/Montefiore Department of Medicine

Grand Rounds

Medicine Grand Rounds: Anemia Management in Chronic Kidney Disease - Guidelines vs. Evidence

Einstein/Montefiore Department of Medicine Grand Rounds

Thursday, December 10, 2015

8:00 AM: Forchheimer Medical Science Building 3rd Floor Lecture Hall

Speaker & Info

Daniel W. Coyne MD
Professor, Medicine
Division of Renal Diseases
Medical Director, Hemodialysis, Chromalloy American Kidney Center
Director, Medicine Multispecialty Clinics
Washington University School of Medicine

Repeated at 12:15 pm, Cherkasky Auditorium, Montefiore Medical Center.

Dr. Daniel Coyne is Professor of Medicine (Renal Diseases), Medical Director at the Chromalloy American Kidney Center, and Director of the Medicine Multispecialty Clinics at Washington University School of Medicine in St. Louis, Missouri. Dr. Coyne received his MD from Case Western Reserve School of Medicine in Cleveland, Ohio. He performed his internship and residency at Emory University, and a fellowship in the Renal Division at Washington University School of Medicine. He joined the Washington University faculty in 1993, and has been a full Professor since 2005.

Dr. Coyne's research interests include the use of ESAs, such as epoetin, for treatment of anemia in CKD and dialysis patients. He was lead investigator of the DRIVE and DRIVE II trials demonstrating the efficacy of IV iron in anemic patients receiving high doses of ESAs. He has also published original research and influential commentaries on how anemia guidelines promoted higher use of ESAs despite emerging safety and efficacy issues. Using some of his research and commentaries, his presentation today will review how anemia in CKD is managed, why ESAs became so profitable, and how renal anemia guidelines promoted increasingly aggressive use of ESAs and anemia treatment, despite trial evidence of serious safety concerns and inflated clinical benefits.

Consequently, Dr. Coyne's talk, "Anemia Management in Chronic Kidney Disease: Guidelines versus Evidence", is a cautionary tale for physicians and trainees about industry's potential to influence clinical guidelines.

Objectives - After attending this activity, participants will be able to:

  1. Understand the relationship and variability of Erythropoiesis-stimulating agent (ESA) dose to hemoglobin response in CKD patients
  2. Understand the safety issues with the use of ESA agents, and how and when to use ESAs in CKD-associated anemia
  3. Understand that clinical surrogate targets such as higher hemoglobin can strongly associate with better outcomes, while treating patients to higher hemoglobin can lead to worse outcomes
  4. Develop skills to evaluate the evidence underlying a clinical guideline to determine if such guidance is valid and applicable to your patients

Accreditation: Albert Einstein College of Medicine designates this educational activity for a maximum of 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity. Albert Einstein College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Host: Division of Nephrology (Department of Medicine)

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