Here’s a list of anti-diabetic drugs commonly recommended for CKD (Chronic Kidney Disease) patients along with their dose adjustments: 1. Metformin • Use: First-line therapy in type 2 diabetes. • CKD Use: Can be used safely in patients with eGFR ≥ 30 mL/min/1.73 m². • Dose Adjustment: • eGFR ≥ 60: No adjustment. • eGFR 45-59: Continue, but monitor renal function every 3-6 months. • eGFR 30-44: Reduce dose to 50% of the maximum dose (i.e., 1000 mg/day) and monitor closely. • eGFR < 30: Contraindicated. 2. SGLT2 Inhibitors (e.g., Empagliflozin, Dapagliflozin, Canagliflozin) • Use: Preferred in CKD patients due to renal protection. • Dose Adjustment: • eGFR ≥ 45: No adjustment needed. • eGFR 30-44: May continue if already on therapy; avoid initiating. • eGFR < 30: Empagliflozin and Dapagliflozin are approved for use in CKD patients. 3. GLP-1 Receptor Agonists (e.g., Liraglutide, Semaglutide, Dulaglutide) • Use: Preferred in CKD for cardiovascular and renal benefits. • Dose Adjustment: • Liraglutide and Semaglutide (subcutaneous): No dose adjustment required in CKD, but monitor renal function. • Exenatide: Avoid if eGFR < 30. • Dulaglutide: No adjustment needed, but caution if eGFR < 30. 4. DPP-4 Inhibitors (e.g., Sitagliptin, Saxagliptin, Linagliptin, Alogliptin) • Use: Safe in CKD with dose adjustments. • Dose Adjustment: • Linagliptin: No adjustment required (excreted via bile). • Sitagliptin: • eGFR ≥ 45: 100 mg daily. • eGFR 30-44: 50 mg daily. • eGFR < 30: 25 mg daily. • Saxagliptin: Avoid if eGFR < 45 due to heart failure risk. • Alogliptin: • eGFR ≥ 60: 25 mg daily. • eGFR 30-59: 12.5 mg daily. • eGFR < 30: 6.25 mg daily. 5. Insulin • Use: Preferred in advanced CKD stages. • Dose Adjustment: • In CKD, insulin clearance decreases, so dose requirements often decrease. • Start with lower doses and monitor for hypoglycemia. 6. Sulfonylureas (e.g., Glimepiride, Gliclazide, Glipizide) • Use: Avoid long-acting agents; prefer short-acting agents like Glipizide. • Dose Adjustment: • Glipizide: No adjustment required in CKD. • Glimepiride: • eGFR < 60: Start at a lower dose (1 mg/day) and titrate carefully. • Gliclazide: Can be used with caution, but avoid in advanced CKD. 7. Thiazolidinediones (e.g., Pioglitazone) • Use: Generally safe in CKD but avoid in patients with heart failure. • Dose Adjustment: • No adjustment required, but monitor for fluid retention. Summary of Preferred Drugs in CKD: Drug Class Examples Preferred in CKD? Key Considerations Metformin Metformin Yes (eGFR ≥ 30) Avoid if eGFR < 30 SGLT2 Inhibitors Empagliflozin, Dapagliflozin Yes (Renal protective) Can be used in eGFR ≥ 30 GLP-1 Agonists Liraglutide, Semaglutide Yes Cardiovascular and renal benefits DPP-4 Inhibitors Sitagliptin, Linagliptin Yes Dose adjustments needed Insulin Various types Yes Dose reduction may be needed Sulfonylureas Glipizide, Glimepiride Use with caution Avoid long-acting agents Thiazolidinediones Pioglitazone Use with caution Monitor for heart failure. *Courtesy of Dcm Mugo- CME GROUP*