Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Abstract

Diabetic kidney disease (DKD) is the major contributor to the mortality and the financial burden of diabetes, accounting for approximately 50% of the cases of end‐stage renal disease (ESRD) in the developed world. Several studies have already demonstrated that achieving blood pressure targets in DKD with agents blocking the renin‐angiotensin system confer superior renoprotection when compared to other agents. However, the effects on renal outcomes of antihyperglycaemic agents in these patients have not been reported or studied broadly until recent years. The intent of this article is to review the available data on safety, efficacy, impact on renal outcomes and pathophysiology implications of the most utilized antihyperglycaemic agents in DKD/ESRD.

Saxagliptin and vildagliptin lowered albuminuria in patients with diabetes and hypertension independent on glycaemic control

“…Herein, the effect of saxagliptin on body weight compared with vildagliptin and control was nonsignificant. In consistence with our findings, previous studies showed that DPP‐4 inhibitors are weight neutral 11,51‐53 …”

“…In consistence with our findings, previous studies showed that DPP-4 inhibitors are weight neutral. 11,[51][52][53] Comparing the findings of saxagliptin and vildagliptin in the current study regarding glycaemic changes, both drugs showed similar reductions in HbA 1c . This was in parallel with Li et al 54 who reported that there was no significant difference amongst saxagliptin, vildagliptin or sitagliptin regarding HbA 1c changes after 24 weeks of treatment in diabetic patients on the combination of metformin and other traditional antidiabetic agents.…”

“…Dipeptidyl peptidase-4 (DPP-4) inhibition is a promising oral treatment for T2D either as monotherapy or in combination with other antidiabetic agents. 10,11 This inhibition results in increased insulin secretion and reduced glucagon production by preventing the inactivation of glucose-dependent insulinotropic polypeptide glucagon-like peptide-1 (GLP-1), the two main incretin hormones. 12 Numerous clinical studies have demonstrated that incretin-based therapies are superior to traditional oral hypoglycaemic agents in terms of clinical efficacy and tolerability.…”