Oral antidiabetic agents: how much kidney disease can we tolerate?

Abstract

Type 2 diabetes mellitus and chronic kidney disease in mild and moderate stages is a common and underestimated comorbidity with relevant therapeutic consequences. Available oral antidiabetic agents are effectively used in keeping blood glucose levels within the guideline range but long lists of contraindications often limit their use. Chronic kidney disease is a very common reason to withhold or discontinue an oral antidiabetic therapy, precluding many patients from drugs with proven benefit, such as metformin. Often contraindications are not based on data but on theoretical grounds or expert opinion. In this review, we critically review threshold levels of kidney function for common oral antidiabetic agents, the evidence from which they were derived and offer advice on how to monitor kidney function as an important procedure in clinical practice.

Keywords::

• chronic kidney disease
• glomerular filtration rate
• oral antidiabetic agents
• Type 2 diabetes mellitus
• renal failure