Oral glucose lowering drugs in type 2 diabetic patients with chronic kidney disease

Abstract

chronic kidney disease (cKD) represents a challenge in the treatment of type 2 diabetic patients. renal impairment may affect drug clearance and other pharmacokinetic processes which can increase toxicity and drug to drug interactions or cause ineffective therapy. there are many oral glucose lowering drugs available for the treatment of type 2 diabetes mellitus (t2DM) with different mechanisms of action and different pharmacokinetic profiles. While all classes may be used in patients with mild renal impairment, therapeutic options for patients with moderate to severe cKD are still limited. this review focuses on the pharmacokinetics, metabolism, and safety of oral glucose lowering drugs in patients with t2DM and cKD.

Comparative pharmacokinetics of catalpol and acteoside in normal and chronic kidney disease rats after oral administration of Rehmannia glutinosa extract

“…CKD is becoming more common (Bastiansen et al, 2013;McDonald et al, 2014). Renal impairment may affect drug clearance and other pharmacokinetic processes, which can increase toxicity and drug-drug interactions or cause ineffective therapy (Nogueira et al, 2013). Renal impairment may affect drug clearance and other pharmacokinetic processes, which can increase toxicity and drug-drug interactions or cause ineffective therapy (Nogueira et al, 2013).…”

“…Patients with CKD are at increased risk of developing acute kidney injury and subsequently requiring renal replacement therapy (Panwar et al, 2013). Renal impairment may affect drug clearance and other pharmacokinetic processes, which can increase toxicity and drug-drug interactions or cause ineffective therapy (Nogueira et al, 2013). Thus, when RG is used by patients with CKD, the drug pharmacokinetic behavior in vivo could be affected by the altered drug disposition (Dixon et al, 2014;Sun et al, 2006;Verbeeck and Musuamba 2009).…”

Persistence of oral antidiabetic treatment for type 2 diabetes characterized by drug class, patient characteristics and severity of renal impairment: A Japanese database analysis

“…5 In general, all OADs can be used in patients with mild RI; however, treatment options for patients with moderate-to-severe chronic kidney disease or end-stage renal disease (ESRD) are limited because reduced GFR may lead to drug or metabolite accumulation and subsequent side effects. 7 Because T2DM requires long-term treatment, patients must remain adherent to and persistent with their prescribed OADs to optimize clinical benefits. 8 According to the World Health Organization, non-adherence to long-term medications for diseases such as hypertension, dyslipidaemia and diabetes is common, leading to compromised clinical outcomes and major economic consequences.…”

Sugar-Lowering Drugs for Type 2 Diabetes Mellitus and Metabolic Syndrome—Review of Classical and New Compounds: Part-I

“…The name of this disease is derived from a Greek word meaning "going through" and a Latin word for "honey" or "sweet" [1] and is characterized by the production of a large amount of urine with a honey-like taste [2]. DM is a metabolic disorder characterized by chronic hyperglycemia together with disturbances in the metabolism of carbohydrates, proteins and fat, which in general results from an insulin availability and need imbalance [1,[3][4][5]. Nowadays, the number of people suffering from DM and its complications is increasing, in part due to the current worldwide lifestyle: Sedentary lifestyle, high-fat diet, obesity and longer life span [6].…”

“…DM can be manifested as type 1, also named insulin-dependent DM (T1DM or IDDM), or type 2, also called non-insulin-dependent DM (T2DM or NIDDM) [7,8]. T1DM represents about 10% of the DM cases in United States and Europe and results from the destruction of insulin-secreting pancreatic β-cells by an autoimmune-mediated process that may, under certain circumstances, have been triggered by a viral infection [3,4,8]. The pancreatic islets are infiltrated by T-lymphocytes and the autoantibodies islet cell antibodies (ICA), and insulin autoantibodies (IAA) can be detected.…”