Table 3 Treatment of hyperglycemia in the patient with type 2 diabetes mellitus and chronic kidney disease
From: Diabetic nephropathy
| Â | Â | Â | Â | Stage of Renal Disease | ||
|---|---|---|---|---|---|---|
| Â | Clearance | Reduction of HbA1c | Risk of hypoglycemia | III | IV | V |
Hepatic metabolism: 100%. Excretion: bile and feces 50% and urine 50% | -1.5% | High (active metabolites) | Avoid | Avoid | Avoid | |
Glipizide [154] | Excretion: metabolites 90% in urine and feces. 10% excreted without metabolization | -1.5% | Low | Can be used | Can be used | Can be used (adjustments) |
Glimepyride | Hepatic metabolism 100%. Excretion: urine 60% and feces 40% | -1.5% | Low | Can be used | Can be used | Use with care |
Hepatic metabolism: 100%. Excretion: 10% urine and 90% feces | -1.0% | Low | Can be used | Can be used | Use with care. Adjust dose | |
Hepatic metabolism: 85%. Excretion: urine 83% and feces 10%. 15% excreted inactive in urine | -0.7% | High (active metabolites) | Use with care | Use with care | Avoid if possible | |
Excretion: urine 34%, feces 51% and <2% in urine in the free or active metabolic form | -0.6% | Low | Can be used | 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 | Can be used | 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 | Can be used | Can be used |
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 | Can be used | Not recommended |
Exanetide [173] | Metabolism and renal excretion | -1.0%** | Low | Can be used | Not recommended | Not recommended |