drug dosing and prescription in ckd & esrd (updates - highlights)

Drug Dosing and Prescription in CKD & ESRDUpdates - Highlights

Mohammed Abdel GawadNephrology Specialist

Kidney & Urology Center (KUC)

Alexandria – EGY

drgawad@gmail.com

6th Nephro Alex, 27-29 July, 2017

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To get the presentation with full animations and videos please contact me on

drgawad@gmail.com

For more presentations visit www.NephroTubeCNE.com

Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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Nature Reviews Nephrology 13, 11–26 (2017)

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Nature Reviews Nephrology 13, 11–26 (2017)

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Am J Med. 2017 Jun;130(6S):S63-S72

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Eur Rev Med Pharmacol Sci. 2017 Jan;21(1):199-211.

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Diabetes Metab Syndr. 2017 Mar 31

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Cardiovascular Diabetology201716:65

Diabetes Metab Syndr. 2017 Mar 31

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Cardiovascular Diabetology201716:65

Take care of: • OVER diuresis (better to avoid diuretics with this combination)

• Dehydration• NSAIDs

• Hypotension• Risk of volume depletion

Diabetes Metab Syndr. 2017 Mar 31

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Euglycemic ketoacidosis is an uncommon complication associated with SGLT-2 inhibitors

• A decrease in insulin levels as a result of insulin-independent hypoglycemia leading to increased lipolysis

• A primary increase in glucagon secretion via direct effects on SGLT2 transporters expressed in pancreatic alpha cells leading to increased ketogenesis

Am J Kidney Dis. 2017 Jun;69(6):A11-A13

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Diabetes Metab Syndr. 2017 Mar 31

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Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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Ann Intern Med. 2011;154:602-13.

Safely used in patients with an estimated glomerular filtration rate as low as 30 mL/min/1.73 m2

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Previous Era

Ann Intern Med. 2017;166(8):572-578.

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J Am Soc Nephrol. 2017 May 2. in press

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J Am Soc Nephrol. 2017 May 2. in press

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Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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20,398 participants

Can J Cardiol. 2017 Jun;33(6):737-746

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Can J Cardiol. 2017 Jun;33(6):705-707

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J Am Coll Cardiol. 2016 Sep 27;68(13):1452-1464

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Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6

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Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6

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Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6

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Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6

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Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6

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Clin J Am Soc Nephrol. 2017 May 8;12(5):744-750.

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Clin J Am Soc Nephrol. 2017 May 8;12(5):744-750.

Regular monitoring of creatine kinase level is suggested

for early detection of febuxostat-associated myopathy, particularly in patients with CKD.

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Medicine (Baltimore). 2017 Jan; 96(2)

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Medicine (Baltimore). 2017 Jan; 96(2)

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Medicine (Baltimore). 2017 Jan; 96(2)

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Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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it was decided to modify the 2009 recommendation to listcalcimimetic therapy now first, in alphabetical order,

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Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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Expert Opin Pharmacother. 2017 Apr;18(5):529-534.

• A peptide calcimimetic agent that has a similar mechanismof action as cinacalcet hydrochloride

• FDA approved (February 7th, 2017)

• Injectable with a longer elimination half-life than cinacalcet

• Frequency of gastrointestinal adverse events has beencomparable between cinacalcet and etelcalcetide

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JAMA. 2017 Jan 10;317(2):156-164

n= 683

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JAMA. 2017 Jan 10;317(2):156-164

n= 683

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JAMA. 2017 Jan 10;317(2):156-164

n= 683

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Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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Int J Res Med Sci. 2016 Nov;4(11):4852-4856

100 cases

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J Med Life. 2016 Oct-Dec; 9(4): 449–454.

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5 grams of sodium bicarbonate in the non-dialysis days

Indian J Nephrol. 2017 May-Jun; 27(3): 190–194.

1 mmol/kg/day of oral bicarbonate

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Talk Outline• New anti diabetic: SGLT-2 Inhibitors

• Update of old debate:

• Metformin

• Warfarin on hemodialysis

• Gout / Hyperuricemia drug alerts

• CKD – MBD Updates:

• KDIGO 2016

• Etelcalcetide

• Oral NaHCO3 with hemodialysis

• Final message

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BMJ.353:i2139. May, 2016

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Int J Drug Dev & Res. 7(4)9-11. October, 2015

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Hosp Pharm. 50(6):505–513, Jun, 2015.

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AKJD. Published online: June 26, 2017

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Thank You