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Table 2 Recommendations for the use of noninsulin antidiabetic agents in CKD

From: Interactions between kidney disease and diabetes: dangerous liaisons

Antidiabetic Agents Recommendations in CKD
Metformin With creatinine clearance 30–45 mL/min/1.73 m2, halve the dose and suspend the drug when the creatinine clearance is <30 mL/min/1.73 m2
Sulfonylureas Use drugs with a short duration of action and suspend the drugs when the creatinine clearance is <45 mL/min/1.73 m2
Glinides These can be used in patients with CKD, although with care when the creatinine clearance is <30 mL/min/1.73 m2
Glitazones (pioglitazone) Their use is associated with water and salt retention, which limits their use in CKD
Alpha-glucosidase inhibitors (acarbose) Their use should be avoided in CKD, due to risk of drug accumulation and consequent hepatotoxicity
Sodium-glucose cotransporter type 2 inhibitors Their use is not indicated with a creatinine clearance <30 mL/min/1.73 m2
Peptide-1 receptor agonists similar to glucagon (GLP-1 RA) Little knowledge in CKD. Gastrointestinal effects are exacerbated in patients with CKD. Use with caution with a creatinine clearance 45–60 mL/min/1.73 m2 and avoid its use in patients with a creatinine clearance <45 mL/min/1.73 m2
Dipeptidyl peptidase-4 (DPP-4) inhibitors Low risk of hypoglycemia. These can be used in CKD. With a creatinine clearance <50 mL/min/1.73 m2, dosage adjustments should be made for vildagliptin, sitagliptin, and saxagliptin. The dose of linagliptin does not require adjustment in CKD