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Antidiabetic drugs and kidney disease--recommendations of the Swiss Society for Endocrinology and Diabetology

Zanchi, Anne
Lehmann, Roger
Published in Swiss Medical Weekly. 2012, vol. 142, w13629
Abstract Patients with diabetes are at risk of early renal function decline. Therefore, kidney function needs monitoring at least once per year. Once the glomerular filtration rate (GFR) is less than 60 ml/min, the pharmacokinetics of antidiabetic drugs may be altered. Sulfonylurea and glinide therapies are associated with a risk of hypoglycaemia which is increased in the presence of renal impairment. Most sulfonylureas must be discontinued once GFR is <60 ml/min. Some glinides may be continued beyond this threshold, in particular repaglinide, which may be used in dialysis patients. In the absence of comorbidities, metformin can be continued at lower doses until a GFR of 45 ml/min, but must be withdrawn in case of dehydration or during the administration of a nephrotoxic drug including dye for radiological investigations. Glitazones may worsen water and sodium retention in patients with renal impairment. The pharmacokinetics of all DPP-IV inhibitors except linagliptin are altered with impaired renal function. Only sitagliptin, saxagliptin and linagliptin may be used in advanced kidney disease, but experience is as yet very limited. GLP-1 agonists are contraindicated in moderate to advanced kidney disease.
Keywords Administration, OralDiabetes Mellitus, Type 2/complications/drug therapy/epidemiologyDiabetic Nephropathies/chemically induced/complications/etiologyGlomerular Filtration Rate/drug effects/physiologyHumansHypoglycemia/chemically induced/complications/etiologyHypoglycemic Agents/administration & dosage/adverse effects/classification/pharmacokineticsIncidenceMonitoring, Physiologic/standardsRenal Insufficiency/chemically induced/etiologyRisk FactorsSwitzerland/epidemiology
PMID: 22987488
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Research group Diabète et régulation des gènes (36)
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ZANCHI, Anne, LEHMANN, Roger, PHILIPPE, Jacques. Antidiabetic drugs and kidney disease--recommendations of the Swiss Society for Endocrinology and Diabetology. In: Swiss Medical Weekly, 2012, vol. 142, p. w13629. doi: 10.4414/smw.2012.13629 https://archive-ouverte.unige.ch/unige:32003

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Deposited on : 2013-12-10

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