From: New strategies to improve clinical outcomes for diabetic kidney disease
Drug class | Example(s) | Mechanism/action | Evidence of kidney protective effects | GFR range (ml/min/ 1.73m2) |
---|---|---|---|---|
Biguanides | Metformin | Reduces hepatic gluconeogenesis [38] | No | >30, lower dose if 30–45 |
Sulfonylureas | Glipizide Gliclazide Glimepiride Glyburide | Stimulates insulin secretion [39] | No | Varies by agent; generally >30 |
Sodium glucose transport protein-2 inhibitors (SGLT-2i) | Canagliflozin Dapagliflozin Empagliflozin Ertugliflozin | Inhibits glucose reabsorption in the kidney thereby lowering blood glucose [40] | Yes (See Table 3, discussion) | Varies by agent; generally >20 |
Glucagon-like Peptide Receptor Agonist (GLP-1 RA) | Exenatide Exenatide ER Liraglutide Albiglutide Dulaglutide Semaglutide | Induces insulin secretion, reduces glucagon release, lowers hepatic gluconeogenesis, slows gastric emptying [50] | Yes (See Table 4, discussion) | Varies by agent; generally >15; Exenatide is contraindicated for GFR <30 or ESKD |
Insulin | Degludec Glargine Detemir NPH Aspart Lispro Glulisine Regular | Â | No | No restriction by GFR, but doses usually must be reduced for GFR <30 |
Dipeptidyl peptidase-4 (DPP4) inhibitors | Sitagliptin Alogliptin Linagliptin Vildagliptin | Prevent GLP-1 degradation, thereby lowering blood glucose [61] | No | Varies by agent; generally >30 except for linagliptin which can be used with lower GFR |
Thiazolidinediones | Pioglitazone | Nuclear transcription regulator and insulin sensitizer [62] | No | No restriction by GFR; watch for worsened fluid retention if eGFR <30 |