Evaluation of the Prevalence of Chronic Kidney Disease and Rates of Oral Antidiabetic Prescribing in Accordance with Guidelines and Manufacturer Recommendations in Type 2 Diabetic Patients within a Long-Term Care Setting
Table 3
Summary of recommendations of dosing adjustments from the NKF guidelines and PI.
Hepatic, with renal excretion of active metabolites
Avoid
Avoid
The initial and maintenance dosing should be conservative
Glipizide
Hepatic, with renal excretion of active metabolites
No dosage adjustment necessary
No dosage adjustment necessary
The initial and maintenance dosing should be conservative
Glimepiride
Hepatic, with renal excretion of active metabolites
Initiate at low dosage, 1 mg daily
Avoid
Initiate at low dosage, 1 mg daily
Alpha-glucosidase Inhibitors
Acarbose
Intestinal
Not recommended in patients with serum creatinine (SCr) > 2 mg/dL
Avoid
Not recommended in patients with SCr > 2 mg/dL
Miglitol
Renal
Not recommended in patients with SCr > 2 mg/dL
Avoid
Not recommended in patients with SCr > 2 mg/dL
Biguanides
Metformin
Renal
Contraindicated with kidney dysfunction defined as SCr ≥1.5 mg/dL in men or ≥1.4 mg/dL in women
Avoid
Contraindicated with kidney dysfunction defined as SCr ≥1.5 mg/dL in men or ≥1.4 mg/dL in women
Meglitinides
Repaglinide
Hepatic
No dosage adjustment necessary
No dosage adjustment necessary
Initiate with 0.5 mg dose for patients with severe renal function impairment (creatinine clearance 20–40 mL/min). Not recommended in patients with creatinine clearance below 20 mL/min or hemodialysis
Nateglinide
Hepatic, with renal excretion of active metabolites
Initiate at low dosage, 60 mg before each meal
Avoid
No dosage adjustment necessary
Thiazolidinediones
Rosiglitazone
Hepatic
No dosage adjustment necessary
No dosage adjustment necessary
No dosage adjustment necessary
Pioglitazone
Hepatic
No dosage adjustment necessary
No dosage adjustment necessary
No dosage adjustment necessary
DPP-4 inhibitors
Sitagliptin
Primarily renal
Reduce dosage by 50% (50 mg/day) when 30 ≤ GFR < 50 mL/min/1.73 m2 and by 75% (25 mg/day) when GFR < 30 mL/min/1.73 m2
Reduce dosage by 75% (25 mg/day)
Reduce dosage to 50 mg once daily when CrCl ≥30 to <50 mL/min, approximately corresponding to serum creatinine levels of >1.7 to ≤3.0 mg/dL in men and >1.5 to ≤2.5 mg/dL in women. Reduce dosage to 25 mg once daily when CrCl <30 mL/min, approximately corresponding to serum creatinine levels of >3.0 mg/dL in men and >2.5 mg/dL in women
Saxagliptin
Both renal and hepatic
Not reported
Not reported
Reduce dosage to 2.5 mg once daily for patients with moderate or severe renal impairment, or end-stage renal disease (CrCl ≤50 mL/min)