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Drug Dosing and Prescription
in CKD & ESRD
Updates - Highlights
Mohammed Abdel Gawad
Nephrology Specialist
Kidney & Urology Center (KUC)
Alexandria – EGY
drgawad@gmail.com
6th Nephro Alex, 27-29 July, 2017
14
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
14
Nature Reviews Nephrology 13, 11–26 (2017)
14
Nature Reviews Nephrology 13, 11–26 (2017)
14
Am J Med. 2017 Jun;130(6S):S63-S72
13
Eur Rev Med Pharmacol Sci. 2017 Jan;21(1):199-211.
13
Diabetes Metab Syndr. 2017 Mar 31
13
Cardiovascular Diabetology201716:65
Diabetes Metab Syndr. 2017 Mar 31
12
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
12
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
12
Diabetes Metab Syndr. 2017 Mar 31
12
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
11
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
11
Previous Era
Ann Intern Med. 2017;166(8):572-578.
11
J Am Soc Nephrol. 2017 May 2. in press
10
J Am Soc Nephrol. 2017 May 2. in press
10
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
10
20,398 participants
Can J Cardiol. 2017 Jun;33(6):737-746
9
Can J Cardiol. 2017 Jun;33(6):705-707
9
J Am Coll Cardiol. 2016 Sep 27;68(13):1452-1464
9
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
8
Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6
8
Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6
8
Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6
7
Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6
7
Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6
7
Clin J Am Soc Nephrol. 2017 May 8;12(5):744-750.
7
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.
7
Medicine (Baltimore). 2017 Jan; 96(2)
6
Medicine (Baltimore). 2017 Jan; 96(2)
6
Medicine (Baltimore). 2017 Jan; 96(2)
6
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
5
5
it was decided to modify the 2009 recommendation to list
calcimimetic therapy now first, in alphabetical order,
5
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
4
Expert Opin Pharmacother. 2017 Apr;18(5):529-534.
• A peptide calcimimetic agent that has a similar mechanism
of action as cinacalcet hydrochloride
• FDA approved (February 7th, 2017)
• Injectable with a longer elimination half-life than cinacalcet
• Frequency of gastrointestinal adverse events has been
comparable between cinacalcet and etelcalcetide
4
JAMA. 2017 Jan 10;317(2):156-164
n= 683
4
JAMA. 2017 Jan 10;317(2):156-164
n= 683
3
JAMA. 2017 Jan 10;317(2):156-164
n= 683
3
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
3
Int J Res Med Sci. 2016 Nov;4(11):4852-4856
100 cases
2
J Med Life. 2016 Oct-Dec; 9(4): 449–454.
2
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
2
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
1
BMJ.353:i2139. May, 2016
1
Int J Drug Dev & Res. 7(4)9-11. October, 2015
1
Hosp Pharm. 50(6):505–513, Jun, 2015.
0
AKJD. Published online: June 26, 2017
0
Thank You

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Drug Dosing and Prescription in CKD & ESRD (Updates - Highlights) - Dr. Gawad

  • 1. Drug Dosing and Prescription in CKD & ESRD Updates - Highlights Mohammed Abdel Gawad Nephrology Specialist Kidney & Urology Center (KUC) Alexandria – EGY drgawad@gmail.com 6th Nephro Alex, 27-29 July, 2017 14
  • 2. To get the presentation with full animations and videos please contact me on drgawad@gmail.com For more presentations visit www.NephroTubeCNE.com
  • 3. 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 14
  • 4. Nature Reviews Nephrology 13, 11–26 (2017) 14
  • 5. Nature Reviews Nephrology 13, 11–26 (2017) 14
  • 6. Am J Med. 2017 Jun;130(6S):S63-S72 13
  • 7. Eur Rev Med Pharmacol Sci. 2017 Jan;21(1):199-211. 13
  • 8. Diabetes Metab Syndr. 2017 Mar 31 13
  • 10. 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 12
  • 11. 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 12
  • 12. Diabetes Metab Syndr. 2017 Mar 31 12
  • 13. 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 11
  • 14. 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 11 Previous Era
  • 15. Ann Intern Med. 2017;166(8):572-578. 11
  • 16. J Am Soc Nephrol. 2017 May 2. in press 10
  • 17. J Am Soc Nephrol. 2017 May 2. in press 10
  • 18. 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 10
  • 19. 20,398 participants Can J Cardiol. 2017 Jun;33(6):737-746 9
  • 20. Can J Cardiol. 2017 Jun;33(6):705-707 9
  • 21. J Am Coll Cardiol. 2016 Sep 27;68(13):1452-1464 9
  • 22. 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 8
  • 23. Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6 8
  • 24. Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6 8
  • 25. Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6 7
  • 26. Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6 7
  • 27. Am J Kidney Dis. 2017 Apr 26. pii: S0272-6386(17)30579-6 7
  • 28. Clin J Am Soc Nephrol. 2017 May 8;12(5):744-750. 7
  • 29. 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. 7
  • 33. 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 5
  • 34. 5
  • 35. it was decided to modify the 2009 recommendation to list calcimimetic therapy now first, in alphabetical order, 5
  • 36. 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 4
  • 37. Expert Opin Pharmacother. 2017 Apr;18(5):529-534. • A peptide calcimimetic agent that has a similar mechanism of action as cinacalcet hydrochloride • FDA approved (February 7th, 2017) • Injectable with a longer elimination half-life than cinacalcet • Frequency of gastrointestinal adverse events has been comparable between cinacalcet and etelcalcetide 4
  • 38. JAMA. 2017 Jan 10;317(2):156-164 n= 683 4
  • 39. JAMA. 2017 Jan 10;317(2):156-164 n= 683 3
  • 40. JAMA. 2017 Jan 10;317(2):156-164 n= 683 3
  • 41. 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 3
  • 42. Int J Res Med Sci. 2016 Nov;4(11):4852-4856 100 cases 2
  • 43. J Med Life. 2016 Oct-Dec; 9(4): 449–454. 2 5 grams of sodium bicarbonate in the non-dialysis days
  • 44. Indian J Nephrol. 2017 May-Jun; 27(3): 190–194. 1 mmol/kg/day of oral bicarbonate 2
  • 45. 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 1
  • 47. Int J Drug Dev & Res. 7(4)9-11. October, 2015 1
  • 49. AKJD. Published online: June 26, 2017 0