Drugs and Kidney: The Art and Responsibility

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Drugs and KidneyThe 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
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(No Transcript)
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Outline

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

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Introduction
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Introduction Drug Use
JAMA. November 2015314(17)1818-1831
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Introduction Cost and cost
Clin J Am Soc Nephrol 10 18221830, October 2015.
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Use of Renally Inappropriate Medications
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Inappropriate Medications
J Am Geriatr Soc 2015 in press
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Inappropriate Medications
J Am Geriatr Soc 2015 in press
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Inappropriate Medications
J Am Geriatr Soc 2015 in press
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Pharmacokinetics
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PharmacokineticsBioavailability in CKD

• Bioavailability
• Furosemide dosing oral/IV
• Gancyclovir
• Drug absorption
• Iron
• Iron and thyroxin

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PharmacokineticsDistribution in CKD

• Distribution
• Free and total
• Digoxin example

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PharmacokineticsMetabolism

• Cytochrome system
• Enzyme inducers and inhibitors

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PharmacogeneticsMetabolism and Transport
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Pharmacokinetics Oral Antidiabetics
Nephrol Dial Transplant (July 2014) 29 12841300
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Pharmacodynamic
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Pharmacodynamics Antidiabetics
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Pharmacodynamics Antibiotics
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Pharmacodynamics Perioperative Management
ACEi /ARBS
OCS
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Pharmacodynamics Glomerular Disease
Clin J Am Soc Nephrol 10 12871290, July 7th,
2015.
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Pharmacogenomics
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Pharmacogenomics
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Preemptive Pharmacogenomics
J Am Med Inform Assoc 201421e93e99.
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TPMT
Nat Rev Drug Discov 2005 4639.
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PharmacogeneticsTacrolimus Scenario
CLINICAL PHARMACOLOGY THERAPEUTICS VOLUME 98
NUMBER 1 JULY 2015
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Tacrolimus Scenario RCT, 240 Patients
Erasmus MC, Rotterdam, The Netherlands
American Journal of Transplantation, 2016
Accepted article
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Diabetes
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Glycemic Control
Nephrol Dial Transplant (May 2015) 30 ii1ii142
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Hypertension
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Hypertension Drug Interactions
J Am Soc Nephrol 26 12481260, June 2015
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Hypertension BB Dialysability
Weir, et al. J Am Soc Nephrol 26 987996, 2015.
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Iron
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Pharmacodynamics Iron Induced Anaphylaxis
JAMA. 17 November 2015314(19)2062-2068
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Iron
Am J Kidney Dis. 2016, in press
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CRUISE
Continuous Replacement Using Iron Soluble
Equivalents Phase 3, RCT, n 599, 48 w
Nephrol Dial Transplant (December 2015) 30
20192026
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PPI
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PPI and Myocardial Infarction
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PPI and CDI
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PPI and Hypomagnesemia
Am J Kidney Dis. 201566(5)775-782
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PPI, Hypomagnesemia and AF
International Journal of Cardiology (2016), in
press
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PPI and Osteoporosis
Bone 81 (2015) 675682
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PPI and Pediatrics

• SBBO
• CDI, Salmonella, Campylob.
• URTI
• CAP, HAP, VAP
• Celiac
• Fundic gastric polyp
• Rebound acidhypersecretion

• Ca Malabsorption and BMD
• VC, B12
• Mg
• CVS
• Interstitial Nephritis
• Microbiome

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Hyperkalemia
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Hyperkalemia New Treatment
N Engl J Med 2015372222-31.
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CKD-MBD
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COMBINE Study
The CKD Optimal Management With BInders and
NicotinamidE study
J Am Soc Nephrol 26 23282339,October 2015
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Statins
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Statins Intolerance
Expert Opin. Drug Saf. (June 2015) 14(6)935-955
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DKD Use of Statins
Nephrol Dial Transplant (May 2015) 30 ii1ii142
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Clarithromycin and Statin
CMAJ, February 17, 2015, 187(3)
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Drug Prescription in Dialysis
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Drugs in Dialysis
Am J Kidney Dis. 201566(1)125-132
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JAMA Nov 2015