drug dosing and prescription in ckd & esrd (updates - highlights)
TRANSCRIPT
Drug Dosing and Prescription in CKD & ESRDUpdates - Highlights
Mohammed Abdel GawadNephrology Specialist
Kidney & Urology Center (KUC)
Alexandria – EGY
6th Nephro Alex, 27-29 July, 2017
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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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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