Selection and dosing of medications for management of diabetes in patients with advanced kidney disease.
Diabetes mellitus is a leading cause of kidney disease worldwide. A large and expanding array of treatments for diabetes is available to improve glycemic control, including newer classes of drugs, such as thiazolidinediones and incretin-based therapies. The presence of impaired kidney function with reduced glomerular filtration rate should influence choices, dosing, and monitoring of hypoglycemic agents, as some agents require a dosing adjustment in patients with kidney disease and some are entirely contraindicated. This article reviews the clinical use of insulin and other antidiabetic therapies, focusing on pharmacokinetic properties and dosing in patients with advanced kidney disease.
Reilly
James B
JB
Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Berns
Jeffrey S
JS
D001645:Biguanides / Q000008:administration & dosage / Q000493:pharmacokinetics; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics; D052216:Glucagon-Like Peptide 1 / Q000008:administration & dosage / Q000493:pharmacokinetics; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D007328:Insulin / Q000008:administration & dosage / Q000493:pharmacokinetics; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000493:pharmacokinetics; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000493:pharmacokinetics
D001645:Biguanides; D054873:Dipeptidyl-Peptidase IV Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D052216:Glucagon-Like Peptide 1