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.

Therapeutic class	Medication	Route of elimination and metabolism	NKF guidelines [15]		PIs [21-33]
			CKD stages 3, 4 or kidney transplant	Dialysis	Renal insufficiency
Second-generation sulfonylureas	Glyburide	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 m^2 and by 75% (25 mg/day) when GFR < 30 mL/min/1.73 m^2	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)
	Linagliptin	Nonrenal pathways	Not reported	Not reported	No dosage adjustment necessary

SD: standard deviation; NKF: National Kidney Foundation; PI: prescribing information; COPD: chronic obstructive pulmonary disease; GFR: glomerular filtration rate; CrCl: creatinine clearance.