Diabetes treatment in patients with renal disease: Is the landscape clear enough?

Table 1 Use of metformin in chronic kidney disease

eGFR (mL/min per 1.73 m2)	Use of metformin
> 60 (CKD 1 and 2)	No contraindication
	Check of renal function annually
45-60 (CKD 3a)	Use of metformin-reduce dose (no more than 1.5-2 g daily)
	Frequent check of renal function (every 3-6 mo)
30-45 (CKD 3b)	Reduce dose (no more than 1-1.5 g daily)
	No new cases
	Frequent check of renal function (every 3-6 mo)
< 30 (CKD 4 and 5)	Stop metformin

CKD: Chronic kidney disease; eGFR: Estimate Glomerular Filtration Rate.

Table 2 Dose adjustment of dipeptidyl peptidase 4 inhibitors in chronic kidney disease

	CKD
	CKD 1, 2 and 3a (Clcr > 50 mL/min)	CKD 3b (Clcr 30-50 mL/min)	CKD stage 4 (Clcr 15-30 mL/min)	CKD stage 5 (ESRD)
Sitagliptin (Januvia)	√ (100 mg × 1)	1/2 dose (50 mg × 1)	1/4 dose (25 mg × 1)	1/4 dose (25 mg × 1)
Vildagliptin (Galvus)	√ (50 mg × 2)	50 mg × 1		50 mg (no experience)
Saxagliptin (Onglyza)	√ (5 mg × 1)	1/2 dose (2.5 mg × 1)	1/2 dose (2.5 mg × 1)	1/2 dose (2.5 mg × 1)
Linagliptin (Trajenta)	√ (5 mg × 1)	√ (5 mg × 1)	√ (5 mg × 1)	P (5 mg × 1)
Alogliptin (Nesina)	√ (25 mg × 1)	1/2 dose (12.5 mg × 1)	1/4 dose (6.25 mg × 1)	1/4 dose (6.25 mg × 1)

CKD: Chronic kidney disease; ESRD: End stage renal disease.