eMedicine Specialties > Nephrology > Acid-Base, Fluid, and Electrolyte Disorders

Hyperkalemia: Differential Diagnoses & Workup

Author: Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine
Coauthor(s): Rosemary Ouseph, MD, Professor of Medicine, Director of Kidney Transplant, University of Louisville School of Medicine; Vibha Nayak, MD, Assistant Professor of Nephrology, Director of Home Dialysis, Kidney Disease Program, University of Louisville; Son Dinh, MD, Nephrologist, Southland Renal Medical Group, Inc
Contributor Information and Disclosures

Updated: Apr 7, 2009

Differential Diagnoses

Other Problems to Be Considered

Pseudohyperkalemia is the term applied to the clinical situation in which in vitro lysis of cellular contents leads to the measurement of a high serum potassium level not reflective of the true in vivo level. This condition occurs most commonly with red cell hemolysis during the blood draw (tourniquet too tight or the blood left sitting too long), severe thrombocytosis (platelet count >1,000,000/mL), or severe leukocytosis (white blood cells [WBCs] >70,000/mL). It is important to recognize that when true intravascular hemolysis has occurred — for example, with a transfusion reaction, a hemolytic sickle crisis, or a drug-induced hemolytic reaction — the measured potassium reflects the true potassium.

Workup

Laboratory Studies

  • Assess renal function.
    • Check serum BUN and creatinine levels to determine whether renal insufficiency is present.
    • Check 24-hour urine for creatinine clearance or estimate the creatinine clearance using the Cockroft-Gault equation to assess whether the degree of renal insufficiency alone explains the hyperkalemia.
    • The Cockroft-Gault equation is (140 – age)(weight in kg)/(72)(serum creatinine). For women, the answer is multiplied by 0.8.
    • Estimate the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula, as follows: (GFR (mL/min/1.73 m2) = 186 x (serum creatinine) - 1.154 x (age) - 0.203 x (0.742 if female) x (1.210 if African American) (conventional units).22
  • Measure urine potassium and sodium concentrations and urine osmolality.
    • These tests are essential to determine whether impairment of renal excretion is contributing to the hyperkalemia. A urine potassium level below 20 mEq/L suggests impaired renal excretion. A urine potassium level greater than 40 mEq/L suggests intact renal excretory mechanisms, implying that high intake or failure of cell uptake is the major mechanism for hyperkalemia. However, an isolated urine potassium level often is misleading, because the concentration of potassium in the urine is influenced not only by secretion by the cortical collecting tubule but also by the degree of urinary concentration. If the urine osmolality is high (>700 mOsm/kg), then the absolute value of urine potassium concentration can be misleading and suggest that the kidneys are disposing of potassium appropriately.
      • For example, suppose serum potassium is 6 mEq/L and urine potassium 60 mEq/L. The high urine potassium level suggests appropriate renal potassium excretion. However, the final concentration of potassium in the urine not only is dependent on how much potassium is secreted in response to sodium reabsorption, but it also is dependent on how concentrated the urine is. In the above example, if urine osmolality is 300 mOsm/kg, that is, not concentrated relative to serum, then a measured urine potassium level of 60 mEq/L indeed suggests renal potassium loss. However, if the urine osmolality is 1200 mOsm/kg, that is, concentrated 4-fold relative to the serum, then the potassium concentration in the urine, in the absence of urinary concentration due to water reabsorption, is 15 mEq/L, which is very low.
      • The conclusion would then be that the kidneys are not appropriately excreting potassium. This adjustment in the evaluation of urinary potassium concentration for the degree of urinary concentration is called calculation of the transtubular potassium gradient (TTKG).
    • TTKG = (urine K x serum osmolarity)/(serum K x urine osmolarity)
      • A TTKG of less than 3 suggests a lack of aldosterone effect on collecting tubules (that is, the kidneys are not excreting potassium appropriately). A TTKG greater than 7 suggests an aldosterone effect, which would be appropriate in the setting of hyperkalemia.
      • These examples demonstrate that calculation of the TTKG is superior to using the urine potassium alone to assess contribution of decreased renal excretion to hyperkalemia. As useful as this test is, it is important to recognize that it is valid only if (1) the urine osmolality is greater than the serum osmolality, that is, the urine is concentrated relative to the serum, and (2) the urine sodium is greater than 20 mEq/L, that is, distal delivery of sodium is adequate for potassium excretion.
    • A 24-hour urine potassium measurement rarely is needed to assess renal potassium excretory ability.
  • Measure complete blood count.
    • A low hemoglobin and hematocrit (H/H) or abnormal red cell morphology may suggest hemolysis.
    • Severe leukocytosis or thrombocytosis raises the possibility of pseudohyperkalemia. When in doubt, measure the plasma potassium concentration. Plasma potassium is about the same as serum potassium.
  • Measure complete metabolic profile.
    • Low bicarbonate may suggest hyperkalemia due to metabolic acidosis.
    • Hyperglycemia suggests diabetes mellitus.
    • Elevated lactic dehydrogenase (LDH), uric acid, phosphate, and alanine aminotransferase (ALT) may suggest tissue breakdown, as occurs in hemolysis, rhabdomyolysis, or tumor lysis.
    • A creatine kinase (CK) elevation suggests rhabdomyolysis.
  • Depending on the results of the above laboratory work, the following may be indicated:
    • Serum cortisol (reference range 8 am 5-25 µg/mL, 4 pm 3-12 µg/mL) - Decrease may suggest adrenal insufficiency.
    • Serum renin and aldosterone (normal supine renin activity 3.2 ± 1 ng/mL/h; normal suppressed aldosterone 5-20 ng/mL) - Decrease may suggest adrenal insufficiency.
    • Fasting blood sugar (reference range 75-115 mg/dL), glycosylated hemoglobin (normal 6.5%), or glucose tolerance test (normal 2 h postprandial value <140 mg/dL) - Increase suggests underlying diabetes mellitus.
    • Assays of 11-beta hydroxylase or 21-hydroxylase - Deficiencies of these enzymes produce syndromes of virilization and generally are recognized in the neonatal period. 11-beta hydroxylase deficiency is diagnosed by measurement of elevated plasma 11-deoxycortisol levels or increased urinary tetrahydro-ll-deoxycortisol levels. To detect mild cases, adrenocorticotropic hormone (ACTH) stimulation also may be performed to enhance synthesis of these products. 21-hydroxylase deficiency is detected by the measurement of elevated 17-hydroxyprogesterone levels in blood, generally 90-1200 nmol/L.

Other Tests

  • Electrocardiogram (ECG) - This test is vital to assess the physiologic significance of the hyperkalemia. However, ECG changes often do not correlate with the degree of hyperkalemia. ECG changes suggestive of an effect of hyperkalemia on cardiac conduction include the following (in order of appearance)23 :
    • Peaked T waves24 (See image below and Image 1.)
    • Prolongation of the PR interval
    • Widening of the QRS (See image below and Image 2.)
    • Loss of the P wave
    • Sine wave pattern
    • Sinus arrest
  • In patients with organic heart disease and abnormal baseline ECG, bradycardia may be the only new ECG abnormality.
Peaked T waves on an electrocardiogram, as seen i...

Peaked T waves on an electrocardiogram, as seen in hyperkalemia.

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Peaked T waves on an electrocardiogram, as seen i...

Peaked T waves on an electrocardiogram, as seen in hyperkalemia.


Widened QRS complexes in a patient whose serum po...

Widened QRS complexes in a patient whose serum potassium level was 7.8 mEq/L.

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Widened QRS complexes in a patient whose serum po...

Widened QRS complexes in a patient whose serum potassium level was 7.8 mEq/L.


More on Hyperkalemia

Overview: Hyperkalemia
Differential Diagnoses & Workup: Hyperkalemia
Treatment & Medication: Hyperkalemia
Follow-up: Hyperkalemia
Multimedia: Hyperkalemia
References
Further Reading
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References

  1. Kahle KT, Ring AM, Lifton RP. Molecular physiology of the WNK kinases. Annu Rev Physiol. 2008;70:329-55. [Medline].

  2. San-Cristobal P, de los Heros P, Ponce-Coria J, et al. WNK kinases, renal ion transport and hypertension. Am J Nephrol. 2008;28(5):860-70. [Medline].

  3. Huang CL, Kuo E. Mechanisms of disease: WNK-ing at the mechanism of salt-sensitive hypertension. Nat Clin Pract Nephrol. Nov 2007;3(11):623-30. [Medline].

  4. Marino PL. Potassium. In: The ICU Book. Baltimore: Williams & Wilkins; 1998.

  5. Preston RA, Afshartous D, Garg D, et al. Mechanisms of impaired potassium handling with dual renin-angiotensin-aldosterone blockade in chronic kidney disease. Hypertension. Mar 23 2009;[Medline].

  6. Khanna A, White WB. The management of hyperkalemia in patients with cardiovascular disease. Am J Med. Mar 2009;122(3):215-21. [Medline].

  7. Matthews JM. Succinylcholine-induced hyperkalemia. Anesthesiology. Aug 2006;105(2):430; author reply 431. [Medline].

  8. Perazella MA, Biswas P. Acute hyperkalemia associated with intravenous epsilon-aminocaproic acid therapy. Am J Kidney Dis. Apr 1999;33(4):782-5. [Medline].

  9. Carroll HJ, Tice DA. The effects of epsilon amino-caproic acid upon potassium metabolism in the dog. Metabolism. May 1966;15(5):449-57. [Medline].

  10. Jarman PR, Kehely AM, Mather HM. Hyperkalaemia in diabetes: prevalence and associations. Postgrad Med J. Sep 1995;71(839):551-2. [Medline]. [Full Text].

  11. Reardon LC, Macpherson DS. Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors. How much should we worry?. Arch Intern Med. Jan 12 1998;158(1):26-32. [Medline]. [Full Text].

  12. Juurlink DN, Mamdani MM, Lee DS. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004;351:543-551. [Medline]. [Full Text].

  13. Paice B, Gray JM, McBride D. Hyperkalaemia in patients in hospital. Br Med J (Clin Res Ed). Apr 9 1983;286(6372):1189-92. [Medline]. [Full Text].

  14. Zietse R, Zoutendijk R, Hoorn EJ. Fluid, electrolyte and acid-base disorders associated with antibiotic therapy. Nat Rev Nephrol. Apr 2009;5(4):193-202. [Medline].

  15. Braden GL, O'Shea MH, Mulhern JG, et al. Acute renal failure and hyperkalaemia associated with cyclooxygenase-2 inhibitors. Nephrol Dial Transplant. May 2004;19(5):1149-53. [Medline]. [Full Text].

  16. Cheng CJ, Lin CS, Chang LW, et al. Perplexing hyperkalaemia. Nephrol Dial Transplant. Nov 2006;21(11):3320-3. [Medline]. [Full Text].

  17. Gowda RM, Cohen RA, Khan IA. Toad venom poisoning: resemblance to digoxin toxicity and therapeutic implications. Heart. Apr 2003;89(4):e14. [Medline]. [Full Text].

  18. New MI. Inborn errors of adrenal steroidogenesis. Mol Cell Endocrinol. 2003;211:75-83. [Medline].

  19. White PC. Aldosterone synthase deficiency and related disorders. Mol Cell Endocrinol. 2004;217:81-87. [Medline].

  20. Sartorato P, Khaldi Y, Lapeyraque AL, et al. Inactivating mutations of the mineralocorticoid receptor in Type I pseudohypoaldosteronism. Mol Cell Endocrinol. Mar 31 2004;217(1-2):119-25. [Medline].

  21. Gamba G. Role of WNK kinases in regulating tubular salt and potassium transport and in the development of hypertension. Am J Physiol Renal Physiol. 2005;288:F245-52. [Medline]. [Full Text].

  22. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. Mar 16 1999;130(6):461-70. [Medline].

  23. Diercks DB, Shumaik GM, Harrigan RA. Electrocardiographic manifestations: electrolyte abnormalities. J Emerg Med. 2004;27:153-160. [Medline].

  24. Chew HC, Lim SH. Electrocardiographical case. A tale of tall T's. Hyperkalaemia. Singapore Med J. Aug 2005;46(8):429-32; quiz 433. [Medline].

  25. Alderman CP. Adverse effects of the angiotensin-converting enzyme inhibitors. Ann Pharmacother. Jan 1996;30(1):55-61. [Medline].

  26. Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. Oct 1995;6(4):1134-42. [Medline].

  27. Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. Nov 1990;38(5):869-72. [Medline].

  28. Allon M, Dunlay R, Copkney C. Nebulized albuterol for acute hyperkalemia in patients on hemodialysis. Ann Intern Med. Mar 15 1989;110(6):426-9. [Medline].

  29. Biswas K, Mulkerrin EC. Potassium homoeostasis in the elderly. QJM. Jul 1997;90(7):487-92. [Medline].

  30. Blaustein DA, Babu K, Reddy A. Estimation of glomerular filtration rate to prevent life-threatening hyperkalemia due to combined therapy with spironolactone and angiotensin-converting enzyme inhibition or angiotensin receptor blockade. Am J Cardiol. 2002;90:662-3. [Medline].

  31. Borra S, Shaker R, Kleinfeld M. Hyperkalemia in an adult hospitalized population. Mt Sinai J Med. May 1988;55(3):226-9. [Medline].

  32. Brewster D. Herbal poisoning: a case report of a fatal yellow oleander poisoning from the Solomon Islands. Ann Trop Paediatr. Dec 1986;6(4):289-91. [Medline].

  33. Cruden NL, Newby DE. Angiotensin antagonism in patients with heart failure: ACE inhibitors, angiotensin receptor antagonists or both?. Am J Cardiovasc Drugs. 2004;4:345-353. [Medline].

  34. Fonarow GC. Managing the patient with diabetes mellitus and heart failure: issues and considerations. Am J Med. 2004;116 Suppl 5A:76S-88S. [Medline].

  35. Gennari FJ. Hyperkalemia: An adaptive response in chronic renal insufficiency. Kidney Int. 2002;62:1-9. [Medline].

  36. Greenberg A. Hyperkalemia: treatment options. Semin Nephrol. Jan 1998;18(1):46-57. [Medline].

  37. Halperin ML, Kamel KS. Potassium. Lancet. Jul 11 1998;352(9122):135-40. [Medline].

  38. Isnard Bagnis C, Deray G, Baumelou A. Herbs and the kidney. Am J Kidney Dis. 2004;44:1-11. [Medline].

  39. Kalemkerian GP, Darwish B, Varterasian ML. Tumor lysis syndrome in small cell carcinoma and other solid tumors. Am J Med. Nov 1997;103(5):363-7. [Medline].

  40. Kark JA, Posey DM, Schumacher HR. Sickle-cell trait as a risk factor for sudden death in physical training. N Engl J Med. Sep 24 1987;317(13):781-7. [Medline].

  41. Kerle KK, Nishimura KD. Exertional collapse and sudden death associated with sickle cell trait. Am Fam Physician. Jul 1996;54(1):237-40. [Medline].

  42. Kilbride HW, Cater G, Warady BA. Early onset hyperkalemia in extremely low birth weight infants. J Perinatol. 1988;8(3):211-4. [Medline].

  43. Martin GB, Nowak RM, Cisek JE. Hyperkalemia during human cardiopulmonary resuscitation: incidence and ramifications. J Emerg Med. Mar-Apr 1989;7(2):109-13. [Medline].

  44. Maschio G, Alberti D, Janin G. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med. Apr 11 1996;334(15):939-45. [Medline].

  45. Michelis MF. Hyperkalemia in the elderly. Am J Kidney Dis. Oct 1990;16(4):296-9. [Medline].

  46. Montoliu J, Almirall J, Ponz E. Treatment of hyperkalaemia in renal failure with salbutamol inhalation. J Intern Med. Jul 1990;228(1):35-7. [Medline].

  47. Moore ML, Bailey RR. Hyperkalaemia in patients in hospital. N Z Med J. Oct 25 1989;102(878):557-8. [Medline].

  48. Mueller BA, Scott MK, Sowinski KM. Noni juice (Morinda citrifolia): hidden potential for hyperkalemia?. Am J Kidney Dis. Feb 2000;35(2):310-2. [Medline].

  49. Oster JR, Singer I, Fishman LM. Heparin-induced aldosterone suppression and hyperkalemia. Am J Med. Jun 1995;98(6):575-86. [Medline].

  50. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. Aug 5 2004;351(6):585-92. [Medline].

  51. Perazella MA. Approach to hyperkalemic end-stage renal disease patients in the emergency department. Conn Med. Mar 1999;63(3):131-6. [Medline].

  52. Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders. Am J Med. Sep 2000;109(4):307-14. [Medline].

  53. Perazella MA. Trimethoprim-induced hyperkalaemia: clinical data, mechanism, prevention and management. Drug Saf. Mar 2000;22(3):227-36. [Medline].

  54. Perazella MA, Mahnensmith RL. Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis. J Gen Intern Med. Oct 1997;12(10):646-56. [Medline].

  55. Pitt B, Remme W, Zannad F. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309-21. [Medline].

  56. Pitt B, Zannad F, Remme WJ. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-717. [Medline].

  57. Schepkens H, Vanholder R, Billiouw JM. Life-threatening hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases. Am J Med. 2001;110:438-441. [Medline].

  58. Shaffer SG, Kilbride HW, Hayen LK. Hyperkalemia in very low birth weight infants. J Pediatr. Aug 1992;121(2):275-9. [Medline].

  59. Shemer J, Modan M, Ezra D. Incidence of hyperkalemia in hospitalized patients. Isr J Med Sci. Jul 1983;19(7):659-61. [Medline].

  60. Struthers AD. The clinical implications of aldosterone escape in congestive heart failure. Eur J Heart Fail. 2004;6:539=545. [Medline].

  61. Takahashi N, Hoshi J, Nishida H. Water balance, electrolytes and acid-base balance in extremely premature infants. Acta Paediatr Jpn. Jun 1994;36(3):250-5. [Medline].

  62. Tamarisa KP, Aaronson KD, Koelling TM. Spironolactone-induced renal insufficiency and hyperkalemia in patients with heart failure. Am Heart J. 2004;148:971-978. [Medline].

  63. Toto R, Shultz P, Raij L. Efficacy and tolerability of losartan in hypertensive patients with renal impairment. Collaborative Group. Hypertension. Feb 1998;31(2):684-91. [Medline].

  64. Tse KC, Yip PS, Lam MF. Star fruit intoxication in uraemic patients: case series and review of the literature. Intern Med J. 2003;33:314-316. [Medline].

  65. Visweswaran P, Guntupalli J. Rhabdomyolysis. Crit Care Clin. Apr 1999;15(2):415-28, ix-x. [Medline].

  66. Weiner ID, Wingo CS. Hyperkalemia: a potential silent killer. J Am Soc Nephrol. Aug 1998;9(8):1535-43. [Medline].

  67. Weir MR. Are drugs that block the renin-angiotensin system effective and safe in patients with renal insufficiency?. Am J Hypertens. Dec 1999;12(12 Pt 3):195S-203S. [Medline].

  68. Wong SL, Maltz HC. Albuterol for the treatment of hyperkalemia. Ann Pharmacother. Jan 1999;33(1):103-6. [Medline].

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Further Reading

Clinical guidelines:
Potassium in pre-dialysis patients. Caring for Australasians with Renal Impairment - Disease Specific Society. 2005 Dec. 6 pages. NGC:006168

The pharmacologic management of chronic heart failure. Department of Veterans Affairs - Federal Government Agency [U.S.]
Veterans Health Administration - Federal Government Agency [U.S.]. 2001 Feb (revised 2003 Aug). 45 pages. NGC:003566

Clinical trials:
Genetic Determinants of the Hypokalemic and Hyperglycemic Effect of Albuterol Inhalation
Inhibition of Aldosterone in Patients With Chronic Renal Disease

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Keywords

hyperkalemia, potassium, high potassium, congestive heart failure, chronic renal failure, potassium foods, potassium health, aldosterone, foods high in potassium, potassium rich foods, potassium levels, potassium food, blood potassium, ACE inhibitor, potassium heart, potassium supplement, ACEI, elevated potassium, potassium effects, symptoms of potassium, high potassium levels, high potassium level, serum potassium, aldosterone renin, Kayexalate, potassium mEq, blood potassium levels, aldosterone renin angiotensin, high potassium causes, hyperkalemia causes, high levels of potassium, high potassium diet, symptoms of high potassium, hypoaldosteronism

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Contributor Information and Disclosures

Author

Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine
Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Rosemary Ouseph, MD, Professor of Medicine, Director of Kidney Transplant, University of Louisville School of Medicine
Rosemary Ouseph, MD is a member of the following medical societies: American Society for Bone and Mineral Research, American Society of Nephrology, and American Society of Transplant Surgeons
Disclosure: Nothing to disclose.

Vibha Nayak, MD, Assistant Professor of Nephrology, Director of Home Dialysis, Kidney Disease Program, University of Louisville
Vibha Nayak, MD is a member of the following medical societies: American Society of Nephrology
Disclosure: Nothing to disclose.

Son Dinh, MD, Nephrologist, Southland Renal Medical Group, Inc
Son Dinh, MD is a member of the following medical societies: American Society of Nephrology and National Kidney Foundation
Disclosure: Nothing to disclose.

Medical Editor

Anil Kumar Mandal, MD, Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida School of Medicine
Anil Kumar Mandal, MD is a member of the following medical societies: American College of Clinical Pharmacology, American College of Physicians, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christie P Thomas, MBBS, FRCP, FASN, FAHA, Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics
Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Nephrology, American Society of Transplantation, American Thoracic Society, International Society of Nephrology, and Royal College of Physicians
Disclosure: Genzyme Grant/research funds Other

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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