Dipeptidyl Peptidase-4 Inhibitors and Diabetic Kidney Disease: A Narrative Review

Abstract

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Severe hypoglycemia: Is it important to take into account the albuminuria value?

“…The authors conclude that in patients with DM2, more advanced CKD was associated with greater insulin use, proposing different explanations of this relationship, however, we consider that in addition to these findings, within the study there are no patients using Dipeptidyl Peptidase-4 Inhibitors (DPP4i), probably by that time they were not being used yet [2]. Therefore, patients with advanced CKD only had insulin as the only option, which explains a greater frequency of its use in this group of patients [3].…”

DPP4 as a Potential Candidate in Cardiovascular Disease

“… 60 Sixthly, DPP4 inhibitor has the ability to downregulate the activity of sodium/hydrogen exchanger-3 (NHE-3), a Na + /H + exchange isomer, to inhibit sodium ion reabsorption in the renal proximal tubules and increase water and sodium excretion, which also explains its beneficial antihypertensive effect. 61 , 62 Seventhly, DPP4 inhibitor interferes with the function of the RAAS system to exert antihypertensive effects as well. DPP4 inhibitor not only reduces circulating angiotensin II, but also affects the expression of angiotensin II receptor (AT), resulting in the downregulation of AT1 receptor and the upregulation of AT2 receptor.…”

Update on diabetic kidney disease

“…Los inhibidores de la Dipeptidil peptidasa-4 (DPP-4i) prolongan la actividad de GLP-1 inhibiendo su catabolismo y se emplean con regímenes de dosificación ajustados en pacientes con ERD (54,55). Estos medicamentos son hipoglucemiantes orales que han demostrado eficacia en el control glucémico de personas con DM tipo 2 y ND, bajo riesgo de hipoglucemia, efecto neutro sobre el peso corporal y un perfil de seguridad cardiovascular que permite su uso en pacientes con ERC (55). No obstante, a pesar que pueden mejorar dos componentes de la ND, como son la hiperglucemia y albuminuria, los ECA no han sido concluyentes con relación a su probable rol en el manejo de la ERD (54).…”