ORAL ANTI DIABETIC DRUGS SAFE IN CKD ( CHRONIC KIDNEY DISEASE ) 

BY DR ANIRBAN BISWAS (MD)

 IN THE PRESENT DECADE , WE ARE SEEING MORE AND MORE PATIENTS OF CKD , WHICH IS ARGUABLY DUE TO THE RISE IN PREVALENCE OF DIABETES AND HYPERTENSION . LET US DISCUSS THE ORAL ANTI-DIABETIC DRUGS WHICH CAN BE GIVEN SAFELY IN VARIOUS STAGES OF CKD AS MEASURED BY GFR .

NOW, NO NEED FOR INSULIN EVEN IN KIDNEY DISEASE

 Glomerular Filtration Rate (GFR) 

Glomerular filtration rate (GFR) is the best measure of kidney function. The GFR is the number used to figure out a person’s stage of kidney disease. A math formula using the person’s age, race, gender and their serum creatinine is used to calculate a GFR. A doctor will order a blood test to measure the serum creatinine level. Creatinine is a waste product that comes from muscle activity. When kidneys are working well they remove creatinine from the blood. As kidney function slows, blood levels of creatinine rise. 

Below shows the five stages of CKD and GFR for each stage: 

CKD AND ANTI-DIABETIC DRUG SAFETY 

1. Stage 5 End Stage CKD (GFR <15 ml/min) 

ONLY REPAGLINIDE (FULL DOSE) AND LINAGLIPTIN ( FULL DOSE WITH CAUTION;1/2 DOSE IS BETTER) CAN BE USED SAFELY.

 2. Stage 4 Severe CKD (GFR = 15-29 ml/min) 

IN ADDITION TO ABOVE , WE CAN USE SITAGLIPTIN 25 MG OD (1/4 REDUCED DOSE) SAXAGLIPTIN 2.5 MG (1/2 REDUCED DOSE) PIOGLITAZONE 7.5 MG (1/2 REDUCED DOSE) 

3. Stage 3B Moderate CKD (GFR = 30-44 mL/min) 

HERE , WE CAN ALSO CONSIDER SITAGLIPTIN 50 MG (1/2 REDUCED DOSE ) GLICLAZIDE (FULL DOSE) ACARBOSE (FULL DOSE) PIOGLITAZONE (FULL DOSE *) METFORMIN 500 MG OD (1/4 REDUCED DOSE) 

4.Stage 3A Moderate CKD (GFR = 45-59 ml/min) 

WE CAN USE METFORMIN 500 MG BID (1/2 REDUCED DOSE) GLIMEPRIDE (FULL DOSE) VOGLIBOSE (FULL DOSE) 

5. Stage 2 Mild CKD (GFR = 60-89 ml/min) 

WE CAN NOW USE SAXAGLIPTIN (FULL DOSE) SITAGLIPTIN (FULL DOSE) METFORMIN (FULL DOSE UPTO 2000 MG*) 

6. Stage 1 with normal or high GFR (GFR > 90 ml/min)

NO RESTRICTION AT ALL NOTE : * PIOGLITAZONE CAN BE USED AT 30 MG /DAY ( BUT, I RECOMMEND ONLY 15 MG /DAY * METFORMIN CAN BE USED UPTO 2500 MG /DAY ( BUT , MOST INDIAN CAN'T TOLERATE IT BEYOND 2000 MG/DAY .