Oral Antidiabetic Agents in Patients with Chronic Kidney Disease

You-Cheol Hwang

doi:10.4093/jkd.2011.12.4.194

Journal List > J Korean Diabetes > v.12(4) > 1054793

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Hwang: Oral Antidiabetic Agents in Patients with Chronic Kidney Disease

Focused Issue

J Korean Diabetes 2011;12(4):194-197.

Published online: 22 January 2011

DOI: https://doi.org/10.4093/jkd.2011.12.4.194

Oral Antidiabetic Agents in Patients with Chronic Kidney Disease

You-Cheol Hwang

Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetes mellitus is the leading cause of chronic kidney disease worldwide. At present, a variety of classes of oral hypoglycemic agents are available to improve glycemic control, including newer classes of drugs such as DPP-IV inhibitors. Decreased renal function with reduced glomerular filtration rate affects the choices, dosing, and monitoring of oral hypoglycemic agents, as some agents require dose adjustments in patients with chronic kidney disease and others are entirely contraindicated. This article reviews the clinical use of oral hypoglycemic agents, focusing on pharmacokinetic properties and dosing in patients with chronic kidney disease.

Keywords: Oral administration, Hypoglycemic agents, Chronic kidney failure

REFERENCES

1. Task Force Team for Basic Statistical Study of Korean Diabetes Mellitus. Report of Task Force Team for Basic Statistical Study of Korean Diabetes Mellitus. Diabetes in Korea 2007. 1st ed.Seoul: Goldfishery;2007. p. 46.

2. Levetan C. Oral antidiabetic agents in type 2 diabetes. Curr Med Res Opin. 2007; 23:945–52.

3. Chipkin SR. How to select and combine oral agents for patients with type 2 diabetes mellitus. Am J Med. 2005; 118(Suppl 5A):4S–13S.

4. Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes: scientific review. JAMA. 2002; 287:360–72.

5. Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs. 2005; 65:385–411.

6. Reilly JB, Berns JS. Selection and dosing of medications for management of diabetes in patients with advanced kidney disease. Semin Dial. 2010; 23:163–8.

7. KDOQI. KDOQI Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007; 49(2 Suppl 2):S12–154.

8. Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care. 2011; 34:1431–7.

9. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B. American Diabetes Association; European Association for Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009; 32:193–203.

10. Committee of Clinical Practice Guideline, Korean Diabetes Association. Treatment guideline for diabetes. 4th ed. J Korean Diabetes. 2011; 12(Suppl 1):65–72.

11. Deacon CF. Dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes: a comparative review. Diabetes Obes Metab. 2011; 13:7–18.

Table 1.

Dosing adjustments by CKD stage for anti-diabetic drugs

Class	Drug	Dosing recommendation
Class	Drug	CKD stages 3,4, or kidney transplant	Dialysis
Sulfonylurea	Glipizide	O	O
	Gliclazide	O	O
	Glyburide	X	X
	Glimepiride	Initiate at low dose, 1 mg daily	X
Alpha-glucosidase inhibitotr	Acarbose	Not recommended in patients with Cr 〉 2 mg/dL	X
Biguanide	Metformin	Table 2	X
Meglitinides	Repaglinide	O	O
	Nateglinide	Initiate at low dose, 60 mg before each meal	X
Thiazolidinediones	Pioglitazone	O	O
	Rosiglitazone	O	O
DPP-IV inhibitors	Sitagliptin	50 mg/day (eGFR 〈 50 mL/min/1.73 m²)	25 mg/day
		25 mg/day (eGFR 〈 30 mL/min/1.73 m²)

Adapted from KDOQI. Am J Kidney Dis 2007;49(2 Suppl 2):S12-154 [7].

CKD, chronic kidney disease; O, no dose adjustment necessary; X, avoid; DPP, dipeptidyl peptidase; eGFR, estimated glomerular filtration rate.

Table 2.

Proposed recommendations for use of metformin based on estimated glomerular filtration rate (eGFR)

eGFR level (mL/min/1.73 m²)	Action
≥ 60	No renal contraindication Monitor renal function annually
45-60	Continue use Monitor renal function every 3-6 months
30-45	Prescribe metformin with caution Use low dose (e.g., 50%, or half-maximal dose) Closely monitor renal function every 3 months Do not start new patients on metformin
‹ 30	Stop metformin

Adapted from Lipska et al. Diabetes Care 2011;34:1431-7 [8].

Additional caution is required in patients at risk for acute kidney injury or with anticipated significant fluctuations in renal status, based on previous history, other comorbidities, or potentially interacting medications.

TOOLS

Similar articles