Table 3

Treatment of hyperglycemia in the patient with type 2 diabetes mellitus and chronic kidney disease

Stage of Renal Disease

Clearance

Reduction of HbA1c

Risk of hypoglycemia

III

Glibenclamide [153,154]

Hepatic metabolism: 100%.

Excretion: bile and feces 50% and urine 50%

-1.5%

High (active metabolites)

Avoid

Glipizide [154]

Excretion: metabolites 90% in urine and feces. 10% excreted without metabolization

-1.5%

Low

Can be used

Can be used (adjustments)

Glimepyride

Hepatic metabolism 100%.

Excretion: urine 60% and feces 40%

-1.5%

Low

Can be used

Use with care

Repaglinide [155,157]

Hepatic metabolism: 100%.

Excretion: 10% urine and 90% feces

-1.0%

Low

Can be used

Use with care.

Adjust dose

Nateglinide [156,158,159]

Hepatic metabolism: 85%.

Excretion: urine 83% and feces 10%. 15% excreted inactive in urine

-0.7%

High (active metabolites)

Use with care

Avoid if possible

Acarbose* [153,160]

Excretion: urine 34%, feces 51% and <2% in urine in the free or active metabolic form

-0.6%

Low

Can be used

Avoid

Rosiglitazone [162]

Hepatic metabolism and excretion in the urine, of rather inactive metabolites in the urine 64% and feces 23%

-0.6 to 1.5%

Low

Can be used

Pioglitazone [162]

Hepatic metabolism and excretion in urine of rather inactive metabolites in the urine 15% and feces 85%

-0.6 to 1.5%

Low

Can be used

Sitaglipitine [171,172]

Excretion: urine 87% and feces 13%, in an unaltered form.

-0.7%

Low

Can be used

Can be used.

Reduce dose 50%

Can be used.

Reduce dose 75%

Vildagliptine

Excretion: urine: 85% and feces 15%.

-0.7%

Low

Can be used

Not recommended

Exanetide [173]

Metabolism and renal excretion

-1.0%**

Low

Can be used

Not recommended

Zelmanovitz et al. Diabetology & Metabolic Syndrome 2009 1:10 doi:10.1186/1758-5996-1-10