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Table 3 Treatment of hyperglycemia in the patient with type 2 diabetes mellitus and chronic kidney disease

From: Diabetic nephropathy

     Stage of Renal Disease
  Clearance Reduction of HbA1c Risk of hypoglycemia III IV V
Glibenclamide [153, 154] 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
Repaglinide [155, 157] Hepatic metabolism: 100%. Excretion: 10% urine and 90% feces -1.0% Low Can be used Can be used Use with care. Adjust dose
Nateglinide [156, 158, 159] 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
Acarbose* [153, 160] 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
Sitaglipitine [171, 172] 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