title: Glucose-lowering drugs in patients with chronic kidney disease: a narrative review on pharmacokinetic properties.
abstract: The achievement of a good glycaemic control is one of the cornerstones for preventing and delaying progression of microvascular and macrovascular complications in patients with both diabetes and chronic kidney disease (CKD). As for other drugs, the presence of an impaired renal function may significantly affect pharmacokinetics of the majority of glucose-lowering agents, thus exposing diabetic CKD patients to a higher risk of side effects, mainly hypoglycaemic episodes. As a consequence, a reduction in dosing and/or frequency of administration is necessary to keep a satisfactory efficacy/safety profile. In this review, we aim to summarize the pharmacology of the most widely used glucose-lowering agents, discuss whether and how it is altered by a reduced renal function, and the recommendations that can be made for their use in patients with different degrees of CKD.
authors: Nephrology-Diabetology Department, AZ Turnhout, Belgium.
authors: Paul
authors: P
authors: Arnouts
authors: European Renal Best Practice Methods Support Team, Ghent University Hospital, Ghent, Belgium CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Calabria, Italy.
authors: Davide
authors: D
authors: Bolignano
authors: European Renal Best Practice Methods Support Team, Ghent University Hospital, Ghent, Belgium Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors: Ionut
authors: I
authors: Nistor
authors: Departments of Internal Medicine, Isala Clinics, Zwolle, the Netherlands University Medical Center, Groningen, the Netherlands.
authors: Henk
authors: H
authors: Bilo
authors: Unit For Metabolic Medicine, Department Diabetes and Endocrinology, Cardiovascular Division, Guy's and St Thomas Hospital, King's College London, London SE1 9NH, UK.
authors: Luigi
authors: L
authors: Gnudi
authors: Department of Nephrology B, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: James
authors: J
authors: Heaf
authors: European Renal Best Practice Methods Support Team, Ghent University Hospital, Ghent, Belgium Renal Division, Ghent University Hospital, Ghent, Belgium.
authors: Wim
authors: W
authors: van Biesen
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000378:metabolism*; D014018:Tissue Distribution
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: chronic kidney disease; diabetes; dialysis; glucose lowering drugs; pharmacokinetics