title: Management of glycemia in diabetic patients with stage IV and V chronic kidney disease.
abstract: Diabetic kidney disease is a leading cause of end-stage kidney disease worldwide. Data suggest that prevention of progression to end-stage may lie in excellent blood glucose control; however, as kidney disease progresses, the risk of hypoglycemia increases, due to unpredictable insulin kinetics and altered pharmacokinetics of hypoglycemic agents. In addition, whole classes of hypoglycemic agents become contraindicated and regimens must be adjusted for declining kidney function. There is no consensus regarding the best therapy for the patient with advanced chronic kidney disease. In the best of circumstances, the care of these patients will involve intensive monitoring, with the input of a team of health care providers creating a coordinated care plan, including dietary advice and a drug regimen tailored to the specific issues faced by the individual patient. An open dialogue is necessary at all times, as patients may become frustrated and attempt self-treatment using over the counter alternatives.
authors.affiliation: Division of Nephrology, SUNY Downstate Medical Center, Box 52, Brooklyn, NY, 11203, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Roche-Recinos
authors.forename: Esti
authors.initials: E
authors.lastname: Charlap
authors.forename: Mariana
authors.initials: M
authors.lastname: Markell
mesh_terms: D000529:Complementary Therapies; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy*
chemical_list: D007004:Hypoglycemic Agents