Drugs and Kidney: The 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: Mansoura NGH; Feb 3 rd, 2016

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

Introduction

JAMA. November 2015;314(17): 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

Pharmacokinetics

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

Pharmacodynamic

Pharmacodynamics: Antidiabetics

Pharmacodynamics: Antibiotics

ACEi /ARBS Pharmacodynamics: Perioperative Management OCS

Clin J Am Soc Nephrol 10: 1287–1290, July 7 th, Pharmacodynamics: Glomerular Disease

Pharmacogenomics

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

Diabetes

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

Hypertension

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

Weir, et al. J Am Soc Nephrol 26: 987–996, Hypertension: BB Dialysability

Iron

JAMA. 17 November 2015;314(19): Pharmacodynamics: Iron Induced Anaphylaxis

Am J Kidney Dis. 2016, in press Iron

Nephrol Dial Transplant (December 2015) 30: 2019–2026 CRUISE Continuous Replacement Using Iron Soluble Equivalents: Phase 3, RCT, n 599, 48 w

PPI

PPI and Myocardial Infarction

PPI and CDI

Am J Kidney Dis. 2015;66(5): 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  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

Hyperkalemia

Hyperkalemia: New Treatment N Engl J Med 2015;372:

CKD-MBD

COMBINE Study J Am Soc Nephrol 26: 2328–2339,October 2015 The CKD Optimal Management With BInders and NicotinamidE study

Statins

Expert Opin. Drug Saf. (June 2015) 14(6): Statins Intolerance

Nephrol Dial Transplant (May 2015) 30: ii1–ii142 DKD: Use of Statins

CMAJ, February 17, 2015, 187(3) Clarithromycin and Statin Clarithromycin and Statin

Drug Prescription in Dialysis

Am J Kidney Dis. 2015;66(1): Drugs in Dialysis

JAMA Nov 2015