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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

9. Cardiovascular Diabetology201716:65
Diabetes Metab Syndr. 2017 Mar 31
12

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

30. Medicine (Baltimore). 2017 Jan; 96(2)
6

31. Medicine (Baltimore). 2017 Jan; 96(2)
6

32. Medicine (Baltimore). 2017 Jan; 96(2)
6

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

46. BMJ.353:i2139. May, 2016
1

47. Int J Drug Dev & Res. 7(4)9-11. October, 2015
1

48. Hosp Pharm. 50(6):505–513, Jun, 2015.
0

49. AKJD. Published online: June 26, 2017
0

50. Thank You