Table 2 Recommendations for the use of noninsulin antidiabetic agents 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