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Related Experiment Videos

[In Process Citation].

Bettina Winzeler1, Michael Dickenmann2, Andreas Werner Jehle2

  • 1Klinik für Endokrinologie, Diabetologie und Metabolismus, Universitätsspital Basel.

Therapeutische Umschau. Revue Therapeutique
|February 28, 2015
PubMed
Summary
This summary is machine-generated.

Diabetic nephropathy management requires individualized glycemic control. Antidiabetic medications need dose adjustments or discontinuation as kidney function declines, especially for sulfonylureas and metformin, to prevent adverse events.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic nephropathy is a leading cause of end-stage renal disease.
  • Early diagnosis and management of albuminuria, hypertension, and hyperglycemia are crucial for renal prognosis.
  • Individualized treatment goals for hyperglycemia are essential.

Purpose of the Study:

  • To review the impact of declining kidney function on antidiabetic medication choices.
  • To highlight necessary dose adjustments and contraindications for various antidiabetic drugs in patients with diabetic nephropathy.

Main Methods:

  • Review of current literature and guidelines on diabetic nephropathy management.
  • Analysis of pharmacokinetic and pharmacodynamic changes of antidiabetic medications with reduced glomerular filtration rate (GFR).

Main Results:

  • Sulfonylureas (glibenclamide, glimepiride) are contraindicated with GFR < 60 ml/min/1.73 m2 due to hypoglycemia risk.
  • Metformin requires dose adjustment at GFR < 60 and cessation at GFR < 45 ml/min/1.73 m2, and should be paused in acute renal failure.
  • DPP-4 inhibitors and GLP-1 receptor agonists require dose adjustments with impaired renal function, with GLP-1 RAs discontinued at GFR < 30 ml/min/1.73 m2.
  • SGLT2 inhibitors (canagliflozin, empagliflozin) can be used with adjusted doses if GFR > 45 ml/min/1.73 m2.

Conclusions:

  • Renal function significantly impacts antidiabetic medication selection and dosing in diabetic nephropathy.
  • Careful medication review and adjustment are necessary to optimize glycemic control while minimizing risks like hypoglycemia and lactic acidosis.
  • Newer agents like SGLT2 inhibitors offer options for patients with moderately impaired kidney function.