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The effects of GLP-1 analogues, DPP-4 inhibitors and SGLT2 inhibitors on the renal system.

Schernthaner G, Mogensen CE, Schernthaner GH - Diab Vasc Dis Res (2014)

Bottom Line: Optimal treatment and prevention of DN may require an early, intensive, multifactorial approach, tailored to simultaneously target all modifiable risk factors.Dipeptidyl peptidase (DPP)-4 inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors lower blood glucose levels without additional risk of hypoglycaemia, and may also reduce albuminuria.Further investigation of the potential renal benefits of DPP-4 and SGLT2 inhibitors is underway.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria guntram.schernthaner@meduniwien.ac.at.

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Related in: MedlinePlus

Antidiabetes therapy in patients with CKD.Source: Modified from Schernthaner et al.,69 by permission of Oxford University Press.CKD: chronic kidney disease; ESRD: end-stage renal disease; RI: renal impairment.aInsulin dosing should be monitored and adjusted depending upon the patient’s response.bSitagliptin dose adjusted to 50 mg once daily for patients with moderate RI, or to 25 mg once daily for patients with severe RI or ESRD.cSaxagliptin dose adjusted to 2.5 mg once daily for patients with moderate-to-severe RI, or ESRD.dVildagliptin dose adjusted to 50 mg once daily for patients with moderate-to-severe RI, or ESRD.eGlimepiride dose should be started at 1 mg daily for all patients with RI.fMetformin dose in patients with moderate RI varies according to national guidelines.
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fig3-1479164114542802: Antidiabetes therapy in patients with CKD.Source: Modified from Schernthaner et al.,69 by permission of Oxford University Press.CKD: chronic kidney disease; ESRD: end-stage renal disease; RI: renal impairment.aInsulin dosing should be monitored and adjusted depending upon the patient’s response.bSitagliptin dose adjusted to 50 mg once daily for patients with moderate RI, or to 25 mg once daily for patients with severe RI or ESRD.cSaxagliptin dose adjusted to 2.5 mg once daily for patients with moderate-to-severe RI, or ESRD.dVildagliptin dose adjusted to 50 mg once daily for patients with moderate-to-severe RI, or ESRD.eGlimepiride dose should be started at 1 mg daily for all patients with RI.fMetformin dose in patients with moderate RI varies according to national guidelines.

Mentions: Because of the favourable tolerability profile of DPP-4 inhibitors (weight neutral and a low incidence of hypoglycaemia) and their potential to preserve β-cell function, these drugs present a unique option in oral glucose-lowering therapy. Currently available DPP-4 inhibitors include sitagliptin, vildagliptin, saxagliptin, alogliptin and linagliptin, and preclinical studies have reported effects on myocardial infarction, and acute and chronic renal failure.63 One of the key differentiators of the available DPP-4 inhibitors is the route of elimination, with sitagliptin, vildagliptin, saxagliptin and alogliptin displaying a variable renal elimination route ranging from 75% for saxagliptin to 87% for sitagliptin.67 In comparison, less than 6% of linagliptin is excreted renally at an oral dosage of 5 mg/day.68 In clinical studies, all DPP-4 inhibitors were well tolerated in patients with CKD,67 with no dose adjustment needed in patients with mild RI. However, dose adjustments are needed in patients with moderate or severe RI for all DPP-4 inhibitors with the exception of linagliptin (Figure 3).


The effects of GLP-1 analogues, DPP-4 inhibitors and SGLT2 inhibitors on the renal system.

Schernthaner G, Mogensen CE, Schernthaner GH - Diab Vasc Dis Res (2014)

Antidiabetes therapy in patients with CKD.Source: Modified from Schernthaner et al.,69 by permission of Oxford University Press.CKD: chronic kidney disease; ESRD: end-stage renal disease; RI: renal impairment.aInsulin dosing should be monitored and adjusted depending upon the patient’s response.bSitagliptin dose adjusted to 50 mg once daily for patients with moderate RI, or to 25 mg once daily for patients with severe RI or ESRD.cSaxagliptin dose adjusted to 2.5 mg once daily for patients with moderate-to-severe RI, or ESRD.dVildagliptin dose adjusted to 50 mg once daily for patients with moderate-to-severe RI, or ESRD.eGlimepiride dose should be started at 1 mg daily for all patients with RI.fMetformin dose in patients with moderate RI varies according to national guidelines.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4230539&req=5

fig3-1479164114542802: Antidiabetes therapy in patients with CKD.Source: Modified from Schernthaner et al.,69 by permission of Oxford University Press.CKD: chronic kidney disease; ESRD: end-stage renal disease; RI: renal impairment.aInsulin dosing should be monitored and adjusted depending upon the patient’s response.bSitagliptin dose adjusted to 50 mg once daily for patients with moderate RI, or to 25 mg once daily for patients with severe RI or ESRD.cSaxagliptin dose adjusted to 2.5 mg once daily for patients with moderate-to-severe RI, or ESRD.dVildagliptin dose adjusted to 50 mg once daily for patients with moderate-to-severe RI, or ESRD.eGlimepiride dose should be started at 1 mg daily for all patients with RI.fMetformin dose in patients with moderate RI varies according to national guidelines.
Mentions: Because of the favourable tolerability profile of DPP-4 inhibitors (weight neutral and a low incidence of hypoglycaemia) and their potential to preserve β-cell function, these drugs present a unique option in oral glucose-lowering therapy. Currently available DPP-4 inhibitors include sitagliptin, vildagliptin, saxagliptin, alogliptin and linagliptin, and preclinical studies have reported effects on myocardial infarction, and acute and chronic renal failure.63 One of the key differentiators of the available DPP-4 inhibitors is the route of elimination, with sitagliptin, vildagliptin, saxagliptin and alogliptin displaying a variable renal elimination route ranging from 75% for saxagliptin to 87% for sitagliptin.67 In comparison, less than 6% of linagliptin is excreted renally at an oral dosage of 5 mg/day.68 In clinical studies, all DPP-4 inhibitors were well tolerated in patients with CKD,67 with no dose adjustment needed in patients with mild RI. However, dose adjustments are needed in patients with moderate or severe RI for all DPP-4 inhibitors with the exception of linagliptin (Figure 3).

Bottom Line: Optimal treatment and prevention of DN may require an early, intensive, multifactorial approach, tailored to simultaneously target all modifiable risk factors.Dipeptidyl peptidase (DPP)-4 inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors lower blood glucose levels without additional risk of hypoglycaemia, and may also reduce albuminuria.Further investigation of the potential renal benefits of DPP-4 and SGLT2 inhibitors is underway.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria guntram.schernthaner@meduniwien.ac.at.

Show MeSH
Related in: MedlinePlus