The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies

Melanie Davies,1,2 Sudesna Chatterjee,1,2 Kamlesh Khunti1,2 1Diabetes Research Centre, University of Leicester, 2Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK Abstract: Worldwide, an estimated 200 million people have chronic kidney disease (CKD), the most com...

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Autores principales:	Davies M, Chatterjee S, Khunti K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/1b8114630ba2446791b7106cce2b9f4a
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spelling	oai:doaj.org-article:1b8114630ba2446791b7106cce2b9f4a2021-12-02T00:28:36ZThe treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies1179-1438https://doaj.org/article/1b8114630ba2446791b7106cce2b9f4a2016-06-01T00:00:00Zhttps://www.dovepress.com/the-treatment-of-type-2-diabetes-in-the-presence-of-renal-impairment-w-peer-reviewed-article-CPAAhttps://doaj.org/toc/1179-1438Melanie Davies,1,2 Sudesna Chatterjee,1,2 Kamlesh Khunti1,2 1Diabetes Research Centre, University of Leicester, 2Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK Abstract: Worldwide, an estimated 200 million people have chronic kidney disease (CKD), the most common causes of which include hypertension, arteriosclerosis, and diabetes. Importantly, ~40% of patients with diabetes develop CKD, yet evidence from major multicenter randomized controlled trials shows that intensive blood glucose control through pharmacological intervention can reduce the incidence and progression of CKD. Standard therapies for the treatment of type 2 diabetes include metformin, sulfonylureas, meglitinides, thiazolidinediones, and insulin. While these drugs have an important role in the management of type 2 diabetes, only the thiazolidinedione pioglitazone can be used across the spectrum of CKD (stages 2–5) and without dose adjustment; there are contraindications and dose adjustments required for the remaining standard therapies. Newer therapies, particularly dipeptidyl peptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors, are increasingly being used in the treatment of type 2 diabetes; however, a major consideration is whether these newer therapies can also be used safely and effectively across the spectrum of renal impairment. Notably, reductions in albuminuria, a marker of CKD, are observed with many of the drug classes. Dipeptidyl peptidase-IV inhibitors can be used in all stages of renal impairment, with appropriate dose reduction, with the exception of linagliptin, which can be used without dose adjustment. No dose adjustment is required for liraglutide, albiglutide, and dulaglutide in CKD stages 2 and 3, although all glucagon-like peptide-1 receptor agonists are currently contraindicated in stages 4 and 5 CKD. At stage 3 CKD or greater, the sodium-glucose cotransporter-2 inhibitors (dapagliflozin, canagliflozin, and empagliflozin) either require dose adjustment or are contraindicated. Ongoing trials, such as CARMELINA, MARLINA, CREDENCE, and CANVAS-R, will help determine the position of these new therapy classes and if they have renoprotective effects in patients with CKD. Keywords: DPP-IV inhibitor, GLP-1RA, SGLT-2 inhibitor, PK, chronic kidney disease, renal impairmentDavies MChatterjee SKhunti KDove Medical PressarticleTherapeutics. PharmacologyRM1-950ENClinical Pharmacology: Advances and Applications, Vol 2016, Iss Issue 1, Pp 61-81 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutics. Pharmacology RM1-950
spellingShingle	Therapeutics. Pharmacology RM1-950 Davies M Chatterjee S Khunti K The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies
description	Melanie Davies,1,2 Sudesna Chatterjee,1,2 Kamlesh Khunti1,2 1Diabetes Research Centre, University of Leicester, 2Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK Abstract: Worldwide, an estimated 200 million people have chronic kidney disease (CKD), the most common causes of which include hypertension, arteriosclerosis, and diabetes. Importantly, ~40% of patients with diabetes develop CKD, yet evidence from major multicenter randomized controlled trials shows that intensive blood glucose control through pharmacological intervention can reduce the incidence and progression of CKD. Standard therapies for the treatment of type 2 diabetes include metformin, sulfonylureas, meglitinides, thiazolidinediones, and insulin. While these drugs have an important role in the management of type 2 diabetes, only the thiazolidinedione pioglitazone can be used across the spectrum of CKD (stages 2–5) and without dose adjustment; there are contraindications and dose adjustments required for the remaining standard therapies. Newer therapies, particularly dipeptidyl peptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors, are increasingly being used in the treatment of type 2 diabetes; however, a major consideration is whether these newer therapies can also be used safely and effectively across the spectrum of renal impairment. Notably, reductions in albuminuria, a marker of CKD, are observed with many of the drug classes. Dipeptidyl peptidase-IV inhibitors can be used in all stages of renal impairment, with appropriate dose reduction, with the exception of linagliptin, which can be used without dose adjustment. No dose adjustment is required for liraglutide, albiglutide, and dulaglutide in CKD stages 2 and 3, although all glucagon-like peptide-1 receptor agonists are currently contraindicated in stages 4 and 5 CKD. At stage 3 CKD or greater, the sodium-glucose cotransporter-2 inhibitors (dapagliflozin, canagliflozin, and empagliflozin) either require dose adjustment or are contraindicated. Ongoing trials, such as CARMELINA, MARLINA, CREDENCE, and CANVAS-R, will help determine the position of these new therapy classes and if they have renoprotective effects in patients with CKD. Keywords: DPP-IV inhibitor, GLP-1RA, SGLT-2 inhibitor, PK, chronic kidney disease, renal impairment
format	article
author	Davies M Chatterjee S Khunti K
author_facet	Davies M Chatterjee S Khunti K
author_sort	Davies M
title	The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies
title_short	The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies
title_full	The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies
title_fullStr	The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies
title_full_unstemmed	The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies
title_sort	treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/1b8114630ba2446791b7106cce2b9f4a
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The treatment of type 2 diabetes in the presence of renal impairment: what we should know about newer therapies

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