1. 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: http://lms.mans.edu.eg/esnt/ Mansoura NGH; Feb 3 rd, 2016

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

4. Introduction

5. JAMA. November 2015;314(17):1818-1831 Introduction: Drug Use

6. Introduction: Cost and cost Clin J Am Soc Nephrol 10: 1822–1830, October 2015.

7. Use of Renally Inappropriate Medications

8. J Am Geriatr Soc 2015 in press Inappropriate Medications

9. J Am Geriatr Soc 2015 in press Inappropriate Medications

10. J Am Geriatr Soc 2015 in press Inappropriate Medications

11. Pharmacokinetics

12. Bioavailability:  Furosemide dosing oral/IV  Gancyclovir Drug absorption  Iron Iron and thyroxin Pharmacokinetics: Bioavailability in CKD

13. Distribution :  Free and total  Digoxin example Pharmacokinetics: Distribution in CKD

14. Cytochrome system :  Enzyme inducers and inhibitors Pharmacokinetics: Metabolism

15. Pharmacogenetics: Metabolism and Transport

16. Nephrol Dial Transplant (July 2014) 29: 1284–1300 Pharmacokinetics: Oral Antidiabetics

17. Pharmacodynamic

18. Pharmacodynamics: Antidiabetics

19. Pharmacodynamics: Antibiotics

20. ACEi /ARBS Pharmacodynamics: Perioperative Management OCS

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

22. Pharmacogenomics

23. Pharmacogenomics

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

25. TPMT Nat Rev Drug Discov 2005; 4:639.

26. CLINICAL PHARMACOLOGY & THERAPEUTICS | VOLUME 98 NUMBER 1 | JULY 2015 Pharmacogenetics: Tacrolimus Scenario

27. Erasmus MC, Rotterdam, The Netherlands American Journal of Transplantation, 2016; Accepted article Tacrolimus Scenario: RCT, 240 Patients

28. Diabetes

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

30. Hypertension

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

32. Weir, et al. J Am Soc Nephrol 26: 987–996, 2015. Hypertension: BB Dialysability

33. Iron

34. JAMA. 17 November 2015;314(19):2062-2068 Pharmacodynamics: Iron Induced Anaphylaxis

35. Am J Kidney Dis. 2016, in press Iron

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

37. PPI

38. PPI and Myocardial Infarction

39. PPI and CDI

40. Am J Kidney Dis. 2015;66(5):775-782 PPI and Hypomagnesemia

41. International Journal of Cardiology (2016), in press PPI, Hypomagnesemia and AF

42. Bone 81 (2015) 675–682 PPI and Osteoporosis

43. 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

44. Hyperkalemia

45. Hyperkalemia: New Treatment N Engl J Med 2015;372:222-31.

46. CKD-MBD

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

48. Statins

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

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

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

52. Drug Prescription in Dialysis

53. Am J Kidney Dis. 2015;66(1):125-132 Drugs in Dialysis

54. JAMA Nov 2015