Noninsulin glucose-lowering agents for the treatment of patients on dialysis.
Chronic kidney disease (CKD) is a common complication of diabetes mellitus and the most common cause of end-stage renal disease (ESRD). As the worldwide prevalence of diabetes continues to increase, the number of patients with CKD will also increase. Therefore, it is essential that physicians know how to safely and effectively manage diabetes in the setting of CKD. Adequate glycaemic control in patients with diabetes is important to prevent ESRD and other complications and to decrease mortality. However, many glucose-lowering agents need to be dose-adjusted or should not be used in the setting of stage 3 CKD or higher (defined as an estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m(2)), particularly in patients with stage 5 CKD (eGFR <15 ml/min/1.73 m(2)) and in those receiving dialysis. Insulin therapy is appropriate for patients undergoing dialysis; however, several orally administered glucose-lowering agents can also be used safely in these patients. In this Review, we provide an overview of the use of noninsulin glucose-lowering agents in the dialysis population.
American Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, IL 60637, USA.
Colleen
C
Flynn
George L
GL
Bakris
D000218:Adamantane / Q000031:analogs & derivatives / Q000627:therapeutic use; D001645:Biguanides / Q000627:therapeutic use; D003928:Diabetic Nephropathies / Q000628:therapy; D004151:Dipeptides / Q000627:therapeutic use; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D018450:Disease Progression; D004763:Glucagon-Like Peptides / Q000627:therapeutic use; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069476:Linagliptin; D008536:Meglumine / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D009570:Nitriles / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D011719:Pyrazines / Q000627:therapeutic use; D011759:Pyrrolidines / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000628:therapy*; D000068900:Sitagliptin Phosphate; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D014498:Uracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077597:Vildagliptin
D001645:Biguanides; D004151:Dipeptides; D054873:Dipeptidyl-Peptidase IV Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D009570:Nitriles; D010880:Piperidines; D011687:Purines; D011719:Pyrazines; D011759:Pyrrolidines; D011799:Quinazolines; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D014230:Triazoles; D000069476:Linagliptin; D014498:Uracil; D004763:Glucagon-Like Peptides; D008536:Meglumine; D008687:Metformin; C502994:saxagliptin; D000077597:Vildagliptin; C520853:alogliptin; D000218:Adamantane; D000068900:Sitagliptin Phosphate