Drugs and Kidney:Drugs and Kidney:The Art and ResponsibilityThe Art and Responsibility

Hussein Sheashaa, MD, FACP Professor of Nephrology, Urology and Nephrology Center and Director of Medical E-Learning

Unit, Mansoura University, and Executive Director of ESNT- Virtual Academy: http://lms.mans.edu.eg/esnt/

Mansoura NGH; Feb 3rd, 2016

Introduction Use of renally inappropriate medication Pharmaco (kinetics, dynamics, genomics) Special drugs and situations Closure

Outline

Introduction

JAMA. November 2015;314(17):1818-1831

Introduction:Drug Use

Introduction:Cost and cost

Clin J Am Soc Nephrol 10: 1822–1830, October 2015.

Use of Renally Inappropriate Medications

J Am Geriatr Soc 2015 in press

Inappropriate Medications

J Am Geriatr Soc 2015 in press

Inappropriate Medications

J Am Geriatr Soc 2015 in press

Inappropriate Medications

PharmacokineticsPharmacokinetics

Bioavailability: Furosemide dosing oral/IV Gancyclovir

Drug absorption Iron

Iron and thyroxin

Pharmacokinetics:Bioavailability in CKD

Distribution: Free and total

Digoxin example

Pharmacokinetics:Distribution in CKD

Cytochrome system: Enzyme inducers and inhibitors

Pharmacokinetics:Metabolism

Pharmacogenetics:Metabolism and Transport

Nephrol Dial Transplant (July 2014) 29: 1284–1300

Pharmacokinetics: Oral Antidiabetics

PharmacodynamicPharmacodynamic

Pharmacodynamics: Antidiabetics

Pharmacodynamics: Antibiotics

ACEi /ARBS

Pharmacodynamics: Perioperative Management

OCS

Clin J Am Soc Nephrol 10: 1287–1290, July 7th, 2015.

Pharmacodynamics: Glomerular Disease

PharmacogenomicsPharmacogenomics

Pharmacogenomics

J Am Med Inform Assoc 2014;21:e93–e99.

Preemptive Pharmacogenomics

TPMT

Nat Rev Drug Discov 2005; 4:639.

CLINICAL PHARMACOLOGY & THERAPEUTICS | VOLUME 98 NUMBER 1 | JULY 2015

Pharmacogenetics:Tacrolimus Scenario

Erasmus MC, Rotterdam, The Netherlands

American Journal of Transplantation, 2016; Accepted article

Tacrolimus Scenario:RCT, 240 Patients

DiabetesDiabetes

Glycemic Control Glycemic Control

Nephrol Dial Transplant (May 2015) 30: ii1–ii142

HypertensionHypertension

J Am Soc Nephrol 26: 1248–1260, June 2015

Hypertension: Drug Interactions

Weir, et al. J Am Soc Nephrol 26: 987–996, 2015.

Hypertension: BB Dialysability

IronIron

JAMA. 17 November 2015;314(19):2062-2068

Pharmacodynamics: Iron Induced Anaphylaxis

Am J Kidney Dis. 2016, in press

Iron

Nephrol Dial Transplant (December 2015) 30: 2019–2026

CRUISEContinuous Replacement Using Iron Soluble

Equivalents: Phase 3, RCT, n 599, 48 w

PPIPPI

PPI and Myocardial Infarction

PPI and CDI

Am J Kidney Dis. 2015;66(5):775-782

PPI and Hypomagnesemia

International Journal of Cardiology (2016), in press

PPI, Hypomagnesemia and AF

Bone 81 (2015) 675–682

PPI and

Osteoporosis

PPI and Pediatrics

SBBOCDI, Salmonella, Campylob.URTICAP, HAP, VAPCeliacFundic gastric polypRebound acidhypersecretion

Ca Malabsorption and BMDVC, B12MgCVSInterstitial NephritisMicrobiome

HyperkalemiaHyperkalemia

Hyperkalemia: New Treatment

N Engl J Med 2015;372:222-31.

CKD-MBDCKD-MBD

COMBINE Study

J Am Soc Nephrol 26: 2328–2339,October 2015

The CKD Optimal Management With BInders and NicotinamidE study

StatinsStatins

Expert Opin. Drug Saf. (June 2015) 14(6):935-955

Statins IntoleranceStatins Intolerance

Nephrol Dial Transplant (May 2015) 30: ii1–ii142

DKD: Use of Statins

CMAJ, February 17, 2015, 187(3)

Clarithromycin and StatinClarithromycin and Statin

Drug Prescription in Drug Prescription in DialysisDialysis

Am J Kidney Dis. 2015;66(1):125-132

Drugs in Dialysis

JAMA Nov 2015