title: [Glucose lowering drugs in case of impaired renal function].
abstract: Evidence-based guidelines describe the optimal implementation order of different classes of anti-diabetic drugs in patients with type 2 diabetes mellitus (DM2). Renal impairment affects 20-40% of the DM2 patients. Guidelines do not provide information about the applicability of individual anti-diabetic drugs in patients with DM2 and impaired renal function. Renal impairment not only affects the pharmacokinetics of anti-diabetic drugs but glucose metabolism as well. Pharmacokinetic properties, as well as clinical experience with individual anti-diabetic drugs, should be used to evaluate the applicability of anti-diabetic drugs. In patients with DM2 and a creatinine clearance ≥ 60 ml/min/1.73 m2 all anti-diabetic drugs can be used at standard doses. In patients with DM2 and a creatinine clearance < 60 ml/min/1.73 m2 certain anti-diabetic drugs are contraindicated, while others should be dose-adjusted. A limited number of anti-diabetic drugs can be dosed independent of renal function.
authors.affiliation: Universitair Medisch Centrum Utrecht, afd. Nefrologie en Hypertensie, Utrecht.
authors.forename: Marijke A J
authors.initials: MA
authors.lastname: Assink
authors.forename: Alferso C
authors.initials: AC
authors.lastname: Abrahams
authors.forename: Maarten B
authors.initials: MB
authors.lastname: Rookmaaker
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000378:metabolism / Q000503:physiopathology*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents