Browse the corpus

Learners’ CME/MOC submission progress will be shown on when such evidence and guidelines were available. All the MKSAP 19 Digital CME/MOC/CPD page. content underwent review by external peer reviewers not on the committee to ensure that the material was balanced and unbiased. Contributors’ disclosure information can Opting in for MOC be found with the list of contributors’ names and those of MKSAP 19 users can opt in for simultaneous submission of ACP principal staff listed in the beginning of this book. CME and MOC points as they answer self-assessment ques- tions. To opt in, users will be required to complete a form requesting their name, date of birth, and ABIM number. Language Reflecting Diversity, Equity, The MOC Opt-in Form will be presented during a user’s and Inclusion Within MKSAP 19 first CME submission and needs to be completed only once. MKSAP 19’s Editors and contributors commit to using language and images that support ACP’s commitment to being an anti-racist organization that supports diversity, ABIM Maintenance of Certification equity, and inclusion throughout health care and health Successful completion of the CME activity, which includes education. ACP also continues to ensure diversity among participation in the evaluation component, enables the par- MKSAP’s physician-contributors. When appropriate, the ticipant to earn up to 300 medical knowledge MOC points MKSAP Editors will also rely on MKSAP 19 Digital’s expanded in the ABIM’s MOC program. It is the CME activity provider’s use of multimedia enhancements, including video and audio, responsibility to submit participant completion information to explore and more fully explain issues surrounding the to ACCME for the purpose of granting MOC credit. presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to contact the Editors at mksap_editors@acponline.org to help us Disclosure Policy identify opportunities for improvement in this area. It is the policy of the American College of Physicians (ACP) to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. To this end, and Hospital-Based Medicine consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con- For the convenience of subscribers who provide care in

Learners’ CME/MOC submission progress will be shown on when such evidence and guidelines were available. All the MKSAP 19 Digital CME/MOC/CPD page. content underwent review by external peer reviewers not on the committee to ensure that the material was balanced and unbiased. Contributors’ disclosure information can Opting in for MOC be found with the list of contributors’ names and those of MKSAP 19 users can opt in for simultaneous submission of ACP principal staff listed in the beginning of this book. CME and MOC points as they answer self-assessment ques- tions. To opt in, users will be required to complete a form requesting their name, date of birth, and ABIM number. Language Reflecting Diversity, Equity, The MOC Opt-in Form will be presented during a user’s and Inclusion Within MKSAP 19 first CME submission and needs to be completed only once. MKSAP 19’s Editors and contributors commit to using language and images that support ACP’s commitment to being an anti-racist organization that supports diversity, ABIM Maintenance of Certification equity, and inclusion throughout health care and health Successful completion of the CME activity, which includes education. ACP also continues to ensure diversity among participation in the evaluation component, enables the par- MKSAP’s physician-contributors. When appropriate, the ticipant to earn up to 300 medical knowledge MOC points MKSAP Editors will also rely on MKSAP 19 Digital’s expanded in the ABIM’s MOC program. It is the CME activity provider’s use of multimedia enhancements, including video and audio, responsibility to submit participant completion information to explore and more fully explain issues surrounding the to ACCME for the purpose of granting MOC credit. presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to contact the Editors at mksap_editors@acponline.org to help us Disclosure Policy identify opportunities for improvement in this area. It is the policy of the American College of Physicians (ACP) to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. To this end, and Hospital-Based Medicine consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con- For the convenience of subscribers who provide care in tributors to all ACP continuing medical education activities hospital settings, comprehensive hospital-focused content

Learners’ CME/MOC submission progress will be shown on when such evidence and guidelines were available. All the MKSAP 19 Digital CME/MOC/CPD page. content underwent review by external peer reviewers not on the committee to ensure that the material was balanced and unbiased. Contributors’ disclosure information can Opting in for MOC be found with the list of contributors’ names and those of MKSAP 19 users can opt in for simultaneous submission of ACP principal staff listed in the beginning of this book. CME and MOC points as they answer self-assessment ques- tions. To opt in, users will be required to complete a form requesting their name, date of birth, and ABIM number. Language Reflecting Diversity, Equity, The MOC Opt-in Form will be presented during a user’s and Inclusion Within MKSAP 19 first CME submission and needs to be completed only once. MKSAP 19’s Editors and contributors commit to using language and images that support ACP’s commitment to being an anti-racist organization that supports diversity, ABIM Maintenance of Certification equity, and inclusion throughout health care and health Successful completion of the CME activity, which includes education. ACP also continues to ensure diversity among participation in the evaluation component, enables the par- MKSAP’s physician-contributors. When appropriate, the ticipant to earn up to 300 medical knowledge MOC points MKSAP Editors will also rely on MKSAP 19 Digital’s expanded in the ABIM’s MOC program. It is the CME activity provider’s use of multimedia enhancements, including video and audio, responsibility to submit participant completion information to explore and more fully explain issues surrounding the to ACCME for the purpose of granting MOC credit. presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to contact the Editors at mksap_editors@acponline.org to help us Disclosure Policy identify opportunities for improvement in this area. It is the policy of the American College of Physicians (ACP) to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. To this end, and Hospital-Based Medicine consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con- For the convenience of subscribers who provide care in tributors to all ACP continuing medical education activities hospital settings, comprehensive hospital-focused content are required to disclose all relevant financial relationships aligned with the ABIM Focused Practice in Hospital Medicine

Learners’ CME/MOC submission progress will be shown on when such evidence and guidelines were available. All the MKSAP 19 Digital CME/MOC/CPD page. content underwent review by external peer reviewers not on the committee to ensure that the material was balanced and unbiased. Contributors’ disclosure information can Opting in for MOC be found with the list of contributors’ names and those of MKSAP 19 users can opt in for simultaneous submission of ACP principal staff listed in the beginning of this book. CME and MOC points as they answer self-assessment ques- tions. To opt in, users will be required to complete a form requesting their name, date of birth, and ABIM number. Language Reflecting Diversity, Equity, The MOC Opt-in Form will be presented during a user’s and Inclusion Within MKSAP 19 first CME submission and needs to be completed only once. MKSAP 19’s Editors and contributors commit to using language and images that support ACP’s commitment to being an anti-racist organization that supports diversity, ABIM Maintenance of Certification equity, and inclusion throughout health care and health Successful completion of the CME activity, which includes education. ACP also continues to ensure diversity among participation in the evaluation component, enables the par- MKSAP’s physician-contributors. When appropriate, the ticipant to earn up to 300 medical knowledge MOC points MKSAP Editors will also rely on MKSAP 19 Digital’s expanded in the ABIM’s MOC program. It is the CME activity provider’s use of multimedia enhancements, including video and audio, responsibility to submit participant completion information to explore and more fully explain issues surrounding the to ACCME for the purpose of granting MOC credit. presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to contact the Editors at mksap_editors@acponline.org to help us Disclosure Policy identify opportunities for improvement in this area. It is the policy of the American College of Physicians (ACP) to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. To this end, and Hospital-Based Medicine consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con- For the convenience of subscribers who provide care in tributors to all ACP continuing medical education activities hospital settings, comprehensive hospital-focused content are required to disclose all relevant financial relationships aligned with the ABIM Focused Practice in Hospital Medicine with any entity producing, marketing, re-selling, or dis- blueprint is integrated throughout the syllabus, and self-

tributors to all ACP continuing medical education activities hospital settings, comprehensive hospital-focused content are required to disclose all relevant financial relationships aligned with the ABIM Focused Practice in Hospital Medicine with any entity producing, marketing, re-selling, or dis- blueprint is integrated throughout the syllabus, and self- tributing health care goods or services consumed by, or assessment questions that are specific to the hospital setting

are required to disclose all relevant financial relationships aligned with the ABIM Focused Practice in Hospital Medicine with any entity producing, marketing, re-selling, or dis- blueprint is integrated throughout the syllabus, and self- tributing health care goods or services consumed by, or assessment questions that are specific to the hospital setting used on, patients. Contributors are required to use generic are specially designated with the blue hospitalist icon ({]). names in the discussion of therapeutic options and are required to identify any unapproved, off-label, or investiga- High Value Care Key Points tive use of commercial products or devices. Where a trade Key Points in the text that relate to High Value Care concepts name is used, all available trade names for the same product (that is, concepts that discuss balancing clinical benefit with type are also included. If trade-name products manufactured costs and harms) are designated by the HVC icon [HVC]. by companies with whom contributors have relationships are discussed, contributors are asked to provide evidence- based citations in support of the discussion. The informa- Educational Disclaimer tion is reviewed by the committee responsible for producing The editors and publisher of MKSAP 19 recognize that the this content. If necessary, adjustments to topics or contrib- development of new material offers many opportunities utors’ roles in content development are made to balance for error. Despite our best efforts, some errors may persist the discussion. Further, all readers of this content are asked in print. Drug dosage schedules are, we believe, accurate to evaluate it for evidence of commercial bias and send any and in accordance with current standards. Readers are relevant comments to mksap_editors@acponline.org so that advised, however, to ensure that the recommended dosages future decisions about content and contributors can be in MKSAP 19 concur with the information provided in the made in light of this information. product information material. This is especially important in cases of new, infrequently used, or highly toxic drugs.

used on, patients. Contributors are required to use generic are specially designated with the blue hospitalist icon ({]). names in the discussion of therapeutic options and are required to identify any unapproved, off-label, or investiga- High Value Care Key Points tive use of commercial products or devices. Where a trade Key Points in the text that relate to High Value Care concepts name is used, all available trade names for the same product (that is, concepts that discuss balancing clinical benefit with type are also included. If trade-name products manufactured costs and harms) are designated by the HVC icon [HVC]. by companies with whom contributors have relationships are discussed, contributors are asked to provide evidence- based citations in support of the discussion. The informa- Educational Disclaimer tion is reviewed by the committee responsible for producing The editors and publisher of MKSAP 19 recognize that the this content. If necessary, adjustments to topics or contrib- development of new material offers many opportunities utors’ roles in content development are made to balance for error. Despite our best efforts, some errors may persist the discussion. Further, all readers of this content are asked in print. Drug dosage schedules are, we believe, accurate to evaluate it for evidence of commercial bias and send any and in accordance with current standards. Readers are relevant comments to mksap_editors@acponline.org so that advised, however, to ensure that the recommended dosages future decisions about content and contributors can be in MKSAP 19 concur with the information provided in the made in light of this information. product information material. This is especially important in cases of new, infrequently used, or highly toxic drugs. Resolution of Conflicts Application of the information in MKSAP 19 remains the professional responsibility of the practitioner. To resolve all conflicts of interest and influences of vested interests, ACP’s content planners used best evidence and The primary purpose of MKSAP 19 is educational. Informa- updated clinical care guidelines in developing content, tion presented, as well as publications, technologies, products,

Resolution of Conflicts Application of the information in MKSAP 19 remains the professional responsibility of the practitioner. To resolve all conflicts of interest and influences of vested interests, ACP’s content planners used best evidence and The primary purpose of MKSAP 19 is educational. Informa- updated clinical care guidelines in developing content, tion presented, as well as publications, technologies, products, vi

and/or services discussed, is intended to inform subscribers with whom ACP has no relationship. We do not honor third about the knowledge, techniques, and experiences of the party sales. CME credits and MOC points cannot be awarded contributors. A diversity of professional opinion exists, and to those purchasers who have purchased the program from the views of the contributors are their own and not those of non-authorized sellers. the ACP. Inclusion of any material in the program does not constitute endorsement or recommendation by the ACP. The ACP does not warrant the safety, reliability, accuracy, com- Unauthorized Use of This Book pleteness, or usefulness of and disclaims any and all liability Is Against the Law for damages and claims that may result from the use of infor- Unauthorized reproduction of this publication is unlawful. mation, publications, technologies, products, and/or services ACP prohibits reproduction of this publication or any of its discussed in this program. parts in any form either for individual use or for distribution. ACP will consider granting an individual permission to Publisher's Information reproduce only limited portions of this publication for Copyright © 2021 American College of Physicians. All rights his or her own exclusive use. Send requests in writing to reserved. MKSAP* Permissions, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572, or This publication is protected by copyright. No part of this email your request to mksap_editors@acponline.org. publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or MKSAP 19 ISBN: 978-1-938245-75-6 mechanical, including photocopy, without the express Nephrology ISBN: 978-1-938245-81-7

reserved. MKSAP* Permissions, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572, or This publication is protected by copyright. No part of this email your request to mksap_editors@acponline.org. publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or MKSAP 19 ISBN: 978-1-938245-75-6 mechanical, including photocopy, without the express Nephrology ISBN: 978-1-938245-81-7 consent of the ACP. MKSAP 19 is for individual use only. Printed in the United States of America. Only one account per subscription will be permitted for the purpose of earning CME credits and MOC points and for For order information in the U.S. or Canada call 800-ACP- other authorized uses of MKSAP 19. 1915. All other countries call 215-351-2600 (Monday to Friday, 9 aM — 5 pM ET). Fax inquiries to 215-351-2799 or email to custserv@acponline.org. Disclaimer Regarding Direct Purchases from Online Retailers CME and/or MOC for MKSAP 19 is available only to custom- Errata and Revisions ers who purchase the program directly from ACP. ACP will Errata and Revisions for MKSAP 19 will be available not set up MKSAP CME/MOC accounts for purchasers of through MKSAP 19 Digital at mksap19.acponline.org as MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), new information becomes known to the editors. vii