PMID- 23461781
OWN - NLM
STAT- MEDLINE
DCOM- 20131024
LR  - 20151119
IS  - 1744-7607 (Electronic)
IS  - 1742-5255 (Linking)
VI  - 9
IP  - 5
DP  - 2013 May
TI  - Pharmacokinetic considerations for the treatment of diabetes in patients with 
      chronic kidney disease.
PG  - 529-50
LID - 10.1517/17425255.2013.777428 [doi]
AB  - INTRODUCTION: People with chronic kidney disease (CKD) of stages 3 - 5 
      (creatinine clearance < 60 ml/min) represent  approximately  25% of patients with type 2 
      diabetes mellitus (T2DM), but the problem is underrecognized or neglected in 
      clinical practice. However, most oral antidiabetic agents have limitations in 
      case of renal impairment (RI), either because they require a dose adjustment or 
      because they are contraindicated for safety reasons. AREAS COVERED: The author 
      performed an extensive literature search to analyze the influence of RI on the 
      pharmacokinetics (PK) of glucose-lowering agents and the potential consequences 
      for clinical practice. EXPERT OPINION: As a result of PK interferences and for 
      safety reasons, the daily dose should be reduced according to glomerular 
      filtration rate (GFR) or even the drug is contraindicated in presence of severe 
      CKD. This is the case for metformin (risk of lactic acidosis) and for many 
      sulfonylureas (risk of hypoglycemia). At present, however, the exact GFR cutoff 
      for metformin use is controversial. New antidiabetic agents are better tolerated 
      in case of CKD, although clinical experience remains quite limited for most of 
      them. The dose of DPP-4 inhibitors should be reduced (except for linagliptin), 
      whereas both the efficacy and safety of SGLT2 inhibitors are questionable in 
      presence of CKD.
FAU - Scheen, Andre J
AU  - Scheen AJ
AD  - University of Liege, Division of Diabetes, Nutrition and Metabolic Disorders, 
      Division of Clinical Pharmacology, Department of Medicine, CHU Sart Tilman (B35), 
      Liege, Belgium. andre.scheen@chu.ulg.ac.be
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20130306
PL  - England
TA  - Expert Opin Drug Metab Toxicol
JT  - Expert opinion on drug metabolism & toxicology
JID - 101228422
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (GLP1R protein, human)
RN  - 0 (Glucagon-Like Peptide-1 Receptor)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Receptors, Glucagon)
RN  - 0 (SLC5A2 protein, human)
RN  - 0 (Sodium-Glucose Transporter 2)
RN  - 0 (Sulfonylurea Compounds)
RN  - 9100L32L2N (Metformin)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Creatinine/urine
MH  - Diabetes Mellitus, Type 2/complications/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/pharmacokinetics/therapeutic use
MH  - Glomerular Filtration Rate
MH  - Glucagon-Like Peptide-1 Receptor
MH  - Humans
MH  - Hypoglycemia/drug therapy
MH  - Hypoglycemic Agents/*pharmacokinetics/*therapeutic use
MH  - Metformin/pharmacokinetics/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Receptors, Glucagon/agonists/genetics/metabolism
MH  - Renal Insufficiency, Chronic/*complications/metabolism
MH  - Sodium-Glucose Transporter 2/genetics/metabolism
MH  - Sulfonylurea Compounds/pharmacokinetics/therapeutic use
EDAT- 2013/03/07 06:00
MHDA- 2013/10/25 06:00
CRDT- 2013/03/07 06:00
PHST- 2013/03/07 06:00 [entrez]
PHST- 2013/03/07 06:00 [pubmed]
PHST- 2013/10/25 06:00 [medline]
AID - 10.1517/17425255.2013.777428 [doi]
PST - ppublish
SO  - Expert Opin Drug Metab Toxicol. 2013 May;9(5):529-50. doi: 
      10.1517/17425255.2013.777428. Epub 2013 Mar 6.