{ "schema_version": 1, "kind": "condition", "id": "chronic-kidney-disease", "name": "Chronic kidney disease (primary care management)", "category": "chronic", "sources": "Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (dapagliflozin monograph) · eMC SmPC, One-Alpha 0.25 microgram soft capsules (Cheplapharm), sections 4.1 and 4.2 · Enalapril maleate tablets US prescribing information, DOSAGE AND ADMINISTRATION - Hypertension and Dosage Adjustment in Hypertensive Patients with Renal Impairment (DailyMed SetID fa93d8e6-2ed2-4a3c-bf6d-33bd0a374efa); clinical position from KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease (kdigo.org/guidelines/blood-pressure-in-ckd)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (dapagliflozin monograph) · eMC SmPC, One-Alpha 0.25 microgram soft capsules (Cheplapharm), sections 4.1 and 4.2 · Enalapril maleate tablets US prescribing information, DOSAGE AND ADMINISTRATION - Hypertension and Dosage Adjustment in Hypertensive Patients with Renal Impairment (DailyMed SetID fa93d8e6-2ed2-4a3c-bf6d-33bd0a374efa); clinical position from KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease (kdigo.org/guidelines/blood-pressure-in-ckd) · Chronic Kidney Disease - disease-level clinical article (chronic-kidney-disease-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 454, "generic": "Dapagliflozin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg once daily", "adult_duration": "Long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (dapagliflozin monograph)", "rationale": "26 live products. Chronic kidney disease is one of the three indications the formulary lists for dapagliflozin, alongside type 2 diabetes and heart failure with reduced ejection fraction, and 10 mg once daily is the fixed non-diabetes dose it gives. Slowing progression, rather than glucose control, is what it is for here.", "cautions": [ "The formulary gives 10 mg once daily as the fixed dose for chronic heart failure and lists chronic kidney disease as an indication without stating a separate dose - it does not describe a different CKD dose.", "Do not start if eGFR is below 25 mL/min/1.73 m2; a patient already established on it may continue. Contraindicated in patients on dialysis.", "The glucose-lowering effect largely disappears below eGFR 45 - the kidney and heart benefit does not, so do not stop it for a rising HbA1c.", "Euglycaemic diabetic ketoacidosis: warn about rapid weight loss, nausea, vomiting, abdominal pain, deep breathing, sleepiness or a metallic taste, and test for ketones even when the glucose looks normal.", "Withhold during acute illness, before surgery, and during prolonged fasting including Ramadan if the patient becomes unwell.", "Genital mycotic infection and, rarely, Fournier's gangrene - counsel on perineal hygiene and on seeking help urgently for perineal pain.", "Expect an initial dip in eGFR of up to about 5 mL/min - this is haemodynamic and is not a reason to stop." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dosing is given in the monograph. Paediatric chronic kidney disease is managed in a specialist centre.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DAPABLIX 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ESRAA PHARMACEUTICAL OPTIMA", "price_egp": 186.0, "pack_count": 30, "unit_price": 6.2, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXIGLOFOZIN 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZETA PHARMA", "price_egp": 195.0, "pack_count": 30, "unit_price": 6.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLIFLOZINO 10 MG 30 F.C.TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INSPIRE PHARMACEUTICAL COMPANY", "price_egp": 214.5, "pack_count": 30, "unit_price": 7.15, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAPAGLIFLOZIN-EVA 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 271.5, "pack_count": 30, "unit_price": 9.05, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZEGAPETS 10 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 280.0, "pack_count": 28, "unit_price": 10.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DIGLIFLOZ 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL", "price_egp": 318.0, "pack_count": 30, "unit_price": 10.6, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAPAVELDACTIN 10 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LIPTIS", "price_egp": 368.0, "pack_count": 28, "unit_price": 13.14, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FORXIGA 10 MG 28 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTRA ZENECA", "price_egp": 602.0, "pack_count": 28, "unit_price": 21.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-kidney-disease" }, { "id": 456, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Chronic Kidney Disease - disease-level clinical article (chronic-kidney-disease-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Avoid nephrotoxic agents including NSAIDs and aminoglycoside antibiotics in CKD patients.", "RED FLAG - Note the warning regarding teratogenicity of ACE inhibitors in pregnant women or women planning pregnancy." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "chronic-kidney-disease" }, { "id": 453, "generic": "Furosemide", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 40.0, "adult_dose": "Oral: Initial: 20-50 mg once then titrate as needed to achieve targeted effect.", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph)", "rationale": "Preferred loop diuretic when eGFR < 30 mL/min as thiazides lose efficacy", "cautions": [ "Monitor volume status and serum electrolytes.", "High doses in severe renal failure require monitoring for ototoxicity.", "May worsen hyperuricaemia." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Acute: Initial: 2 mg/kg as a single dose; if ineffective, may increase in 6 to 8 hours in increments of 1 to 2 mg/kg/dose; maximum dose: 6 mg/kg/dose.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ODEMENT 40MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 1.3, "pack_count": 10, "unit_price": 0.13, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FRUZEX 40MG 12 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 3.25, "pack_count": 12, "unit_price": 0.27, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUROSEMIDE 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 7.5, "pack_count": 20, "unit_price": 0.38, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FURORETIC 40 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > VETOPHARM", "price_egp": 14.25, "pack_count": 30, "unit_price": 0.47, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAFUREX 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 9.5, "pack_count": 20, "unit_price": 0.47, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SALEX 40 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 10.0, "pack_count": 20, "unit_price": 0.5, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUROSEMIDE-ALEX 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 19.0, "pack_count": 20, "unit_price": 0.95, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LASIX 40 MG 24 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 30.0, "pack_count": 24, "unit_price": 1.25, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GENESEMIDE 20MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > VODACHEM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-kidney-disease" }, { "id": 455, "generic": "Alfacalcidol", "line": 3, "is_adjunct": true, "form": "oral.solid", "strength_mg": 0.001, "adult_dose": "1 microgram once daily initially (0.5 microgram once daily in the elderly), adjusted in 0.25-0.5 microgram steps by biochemical response; maintenance is usually 0.25-1 microgram daily, and most adults respond to 1-3 micrograms daily", "adult_duration": "Long-term, titrated to plasma calcium and parathyroid hormone", "dose_source": "eMC SmPC, One-Alpha 0.25 microgram soft capsules (Cheplapharm), sections 4.1 and 4.2", "rationale": "29 live products. The SmPC indication is precisely the disturbance of calcium metabolism caused by impaired 1-alpha hydroxylation in reduced renal function - renal osteodystrophy and hyperparathyroidism with bone disease. That is the mineral and bone axis of chronic kidney disease.", "cautions": [ "This is NOT the drug for simple nutritional vitamin D deficiency. Colecalciferol is, and it is already listed under Vitamin D Deficiency. Alfacalcidol bypasses renal 1-alpha hydroxylation and is for the bone disease of renal failure and for hypoparathyroidism.", "Measure plasma calcium weekly at first, then every 2-4 weeks once stable, and after every dose change.", "Stop for hypercalcaemia - muscle and bone pain, weakness, confusion, dehydration, anorexia, fatigue, nausea and vomiting. Prolonged hypercalcaemia itself worsens renal function.", "Watch the total calcium load if the patient is also on a calcium-containing phosphate binder.", "Hypersensitivity to the active substance, arachis oil (peanut oil), soya or to any of the excipients listed in section 6.1." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children from 6 year of age and under 20 kg bodyweight: 0.05 microgram/kg/day", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SAFEDALFA 1 MCG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAFE PHARMA", "price_egp": 105.0, "pack_count": 30, "unit_price": 3.5, "strength_mg": 0.001, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BONE CARE 1 MCG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CAPS > MULTICARE", "price_egp": 132.0, "pack_count": 30, "unit_price": 4.4, "strength_mg": 0.001, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BON-ONE 1 MCG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > TEIJIN LIMITED-JAPAN", "price_egp": 153.0, "pack_count": 30, "unit_price": 5.1, "strength_mg": 0.001, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CALCIDOL 1 MCG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > MULTIPHARMA", "price_egp": 153.0, "pack_count": 30, "unit_price": 5.1, "strength_mg": 0.001, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ONE ALPHA 1 MCG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > LEO PHARMACEUTICAL PRODUCTS", "price_egp": 200.0, "pack_count": 30, "unit_price": 6.67, "strength_mg": 0.001, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALFACIDOCAL 1 MCG 30 S.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 54.0, "pack_count": null, "unit_price": null, "strength_mg": 0.001, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TAMINORIG 2MCG/ML ORAL DROPS. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 46.0, "pack_count": null, "unit_price": null, "strength_mg": 0.002, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ALFACARENO 2MCG/ML ORAL DROPS. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > GLOBE INTERNATIONAL PHARMACEUTICALS", "price_egp": 152.0, "pack_count": null, "unit_price": null, "strength_mg": 0.002, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-kidney-disease" } ] }