# Chronic kidney disease (primary care management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - Dapagliflozin — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Furosemide — 40 mg — oral.solid - Alfacalcidol — 0.001 mg — oral.solid ## Complete treatment card ```text CHRONIC KIDNEY DISEASE (PRIMARY CARE MANAGEMENT) 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 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) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Early disease causes no symptoms at all; symptoms only show up once function has dropped to stage 4 or 5 - Late-stage complaints include nausea, vomiting, poor appetite, tiredness and weakness, disturbed sleep, and low urine output [fatigue · nausea · poor appetite · vomiting] - Reduced mental sharpness, muscle cramps, swelling of the feet and ankles, and ongoing itching can also occur [itching · muscle cramps] - Chest pain from inflammation around the heart, and breathlessness from fluid backing up into the lungs, can occur in advanced disease [breathlessness · chest pain] - A history of long-standing high blood pressure, protein or blood in the urine, or prostate symptoms points toward a chronic rather than sudden process [blood in the urine · hypertension] SIGNS - what you find (5) - Exam is often unrevealing, but skin pigmentation and scratch marks from itching can be found [itching] - A rubbing sound over the heart can be heard when inflammation surrounds it - A fine white powder can form on the skin from urea crystallizing out of sweat when blood urea nitrogen is very high - Overactive reflexes or muscle twitching, and high-blood-pressure changes seen in the back of the eye, can point to a long-standing process [hypertension] - Thickening of the heart's main pumping chamber on exam also suggests the disease has been present for a while TESTS (10) - A normal parathyroid hormone level favors a sudden kidney injury over long-standing disease, while low calcium and high phosphorus don't help tell the two apart - Kidney function should be rechecked within 2 weeks of a newly found low eGFR when it's unclear whether it's a sudden injury or long-standing disease - Creatinine clearance is used as a practical stand-in for the true reference test, inulin clearance, when estimating filtration rate - Protein in the urine is assessed with an early-morning albumin-to-creatinine ratio, graded from A1 to A3 - When precise measurement isn't available, a dipstick of trace-to-1+ roughly corresponds to 30-299 mg/g of albumin, and 1+ or more to over 300 mg/g - Ultrasound showing small kidneys with a thin outer layer, brighter tissue, scarring, or several cysts points to a chronic process - Doppler ultrasound of the kidney is used when narrowing of the renal artery is suspected - Angiography of the renal arteries can show multiple small bulges and irregular narrowing in vasculitis or renal artery stenosis - Voiding cystourethrography is used mainly when long-standing reflux of urine up toward the kidney is a suspected cause - A kidney biopsy is the reference test for pinning down the underlying cause and grading how much scarring has occurred IF NOT THIS - what else fits (1) - Consider a sudden kidney injury, Alport syndrome, anti-glomerular basement membrane disease, diabetic kidney disease, multiple myeloma, kidney stones, rapidly progressive glomerulonephritis, or renal artery narrowing Source StatPearls "Chronic Kidney Disease" - disease-level clinical article Status traced to the source above Rx: Renoprotection - SGLT2 inhibitor | Main treatment RENOPROTECTION - SGLT2 INHIBITOR 1. DAPAGLIFLOZIN [1st line] Adult 10 mg once daily - Long-term Peds No paediatric dosing is given in the monograph. Paediatric chronic kidney disease is managed in a specialist centre. Source Egyptian National Drug Formulary - Cardiovascular 2024 (dapagliflozin monograph) Why 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. Caution 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. Egypt DAPABLIX 10 MG 30 F.C. TABS. AL ESRAA PHAR... 186.00 EGP (6.20/unit) DEXIGLOFOZIN 10 MG 30 F.C. TABS. ZETA PHARMA 195.00 EGP (6.50/unit) GLIFLOZINO 10 MG 30 F.C.TABS INSPIRE PHARM... 214.50 EGP (7.15/unit) DAPAGLIFLOZIN-EVA 10 MG 30 F.C. TABS. EVA PHARMA 271.50 EGP (9.05/unit) ZEGAPETS 10 MG 28 F.C. TABS. OCTOBER PHARMA 280.00 EGP (10.00/unit) DIGLIFLOZ 10 MG 30 F.C. TABS. MARCYRL 318.00 EGP (10.60/unit) DAPAVELDACTIN 10 MG 28 F.C. TABS. LIPTIS 368.00 EGP (13.14/unit) FORXIGA 10 MG 28 TABS. ASTRA ZENECA 602.00 EGP (21.50/unit) MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Chronic Kidney Disease - disease-level clinical article (chronic-kidney-disease- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution 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. 3. FUROSEMIDE [add-on - not a substitute] Adult Oral: Initial: 20-50 mg once then titrate as needed to achieve targeted effect. - long- term Peds 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. Source Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) Why Preferred loop diuretic when eGFR < 30 mL/min as thiazides lose efficacy Caution Monitor volume status and serum electrolytes. High doses in severe renal failure require monitoring for ototoxicity. May worsen hyperuricaemia. Egypt ODEMENT 40MG 10 TAB. EL NASR 1.30 EGP (0.13/unit) FRUZEX 40MG 12 TAB. MISR 3.25 EGP (0.27/unit) FUROSEMIDE 40MG 20 TAB. SEDICO 7.50 EGP (0.38/unit) FURORETIC 40 MG 30 TABS. DEBEIKY > VET... 14.25 EGP (0.47/unit) LAFUREX 40MG 20 TAB. AMOUN 9.50 EGP (0.47/unit) SALEX 40 MG 20 TABS. ARAB DRUG COM... 10.00 EGP (0.50/unit) FUROSEMIDE-ALEX 40MG 20 TAB. ALEXANDRIA 19.00 EGP (0.95/unit) LASIX 40 MG 24 TABS. SANOFI 30.00 EGP (1.25/unit) GENESEMIDE 20MG/5ML SYRUP 120 ML MEDIZEN PHARM... 56.00 EGP -> ? strength differs, ? different route - not oral solid 4. ALFACALCIDOL [add-on - not a substitute] Adult 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 - Long-term, titrated to plasma calcium and parathyroid hormone Peds Children from 6 year of age and under 20 kg bodyweight: 0.05 microgram/kg/day Source eMC SmPC, One-Alpha 0.25 microgram soft capsules (Cheplapharm), sections 4.1 and 4.2 Why 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. Caution 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. Egypt SAFEDALFA 1 MCG 30 CAPS. SAFE PHARMA 105.00 EGP (3.50/unit) BONE CARE 1 MCG 30 CAPS. ARAB CAPS > M... 132.00 EGP (4.40/unit) BON-ONE 1 MCG 30 TABS. MINA PHARM > ... 153.00 EGP (5.10/unit) CALCIDOL 1 MCG 30 CAPS. KAHIRA > MULT... 153.00 EGP (5.10/unit) ONE ALPHA 1 MCG 30 CAPS. MINA PHARM > ... 200.00 EGP (6.67/unit) ALFACIDOCAL 1 MCG 30 S.G. CAPS. EVA PHARMA 54.00 EGP TAMINORIG 2MCG/ML ORAL DROPS. 10 ML MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 46.00 EGP -> ? strength differs, ? different route - not oral solid ALFACARENO 2MCG/ML ORAL DROPS. 10 ML KAHIRA > GLOBE INTERNATIONAL PHARMA... 152.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)