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Kidney Week

Abstract: FR-PO344

Effect of Virtual Patient Simulation at Improving Management of Chronic Hyperkalemia

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Larkin, Amy, Medscape Education, Nicholasville, Kentucky, United States
  • Anderson, David R., Medscape LLC, New York, New York, United States
  • Warters, Martin, Medscape / WebMD, New York, New York, United States
  • Littman, Gwen S., WebMD, Durham, North Carolina, United States

We sought to determine if an online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of nephrologists related to identification of patients with hyperkalemia, and chronic management of hyperkalemia.


The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a 2-tailed paired t-test to determine P values. The activity posted April 30, 2019; data for initial abstract submission was collected through May 22, 2019.


To date after being live for 3 weeks, 37 nephrologists have participated (larger sample size expected by ASN conference). Significant improvements were observed after CG:
Case 1:
Initiate a loop diuretic: 24% absolute improvement (41% pre-CG vs 65% post-CG; P<.05)
Order nutritional counseling: 19% absolute improvement (41% pre-CG vs 60% post-CG; P=.05)
Initiate a potassium binder: 41% improvement (8% pre-CG vs 49% post-CG; P<.01)
Discontinue spironolactone: 22% improvement (41% pre-CG vs 43% post-CG; P<.05)

Case 2:
Diagnose chronic kidney disease stage 3a: 43% absolute improvement (5% pre-CG vs 48% post-CG; P<.01)
Diagnose heart failure, NYHA (WHO) Class II: 38% absolute improvement (14% pre-CG vs 52% post-CG; P<.01)
Diagnose chronic hyperkalemia: 24% absolute improvement (29% pre-CG vs 53% post-CG; P=.05)
Initiate potassium binder therapy: 57% absolute improvement (19% pre-CG vs 76% post-CG; P<.01)


VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to patient identification and management of hyperkalemia.