Imeglimin in Patients with an Estimated Glomerular Filtration Rate Less than 45 mL/min per 1.73 m²: A Case Series

Imeglimin is a new oral antidiabetic agent that became available in Japan in 2021. It is not recommended for patients with an estimated glomerular filtration rate (eGFR) <45 mL/min per 1.73 m² because of the lack of data regarding such patients. However, imeglimin may be beneficial for patients with chronic kidney disease because basic studies have shown its ability to decrease albuminuria and suppress kidney fibrosis.

We performed a retrospective study of the safety of imeglimin for patients with an eGFR <45 mL/min per 1.73 m². Side effects, renal function, liver function, pH, hydrogen carbonate, carbon dioxide, and glycated hemoglobin A1c when imeglimin was initiated and 3 months after treatment initiation were compared. Fifteen patients (10 male and five female patients) who were newly prescribed imeglimin treatment between October 1, 2021, and April 30, 2024, and had an eGFR <45 mL/min per 1.73 m² at that time were enrolled in this study. However, one patient self-interrupted treatment because of lightheadedness; therefore, 14 patients (10 male and four female patients) were included in the analysis.

No deterioration in renal and hepatic functions occurred. Proteinuria decreased significantly, pH increased significantly, hydrogen carbonate remained unchanged, and carbon dioxide showed a decreasing trend. Subjective symptoms such as hypoglycemia and gastrointestinal symptoms were not observed.

Short-term imeglimin treatment may be safe for patients with an eGFR <45 mL/min per 1.73 m². Further studies of the safety of long-term imeglimin use are warranted.