Managing diabetic patients with moderate or severe renal impairment using DPP-4 inhibitors: focus on vildagliptin

Figures & data

Figure 1 Renal dysfunction is common in patients with type 2 diabetes.

Note: Data are from an Italian cohort of 15,773 patients with T2DM aged 20 years or older participating in the Renal Insufficiency and Cardiovascular Events (RIACE) trial in years 2007–2008.⁹

Table 1 Association between glycemic control and adverse cardiorenal outcomes in people with type 2 diabetes and chronic kidney disease

	HbA1c levels
	<7% n= 10,709 (stage 3) n= 1072 (stage 4)	Stage 3 CKD		Stage 4 CKD
		7%–9% n = 8060	>9% n = 2386	7%–9% n = 793	>9% n = 276
All-cause mortality	1	1.04 (0.96–1.13)	1.35 (1.20–1.53)	1.03 (0.87–1.21)	1.39 (1.10–1.76)
All-cause hospitalization	1	1.09 (1.04–1.15)	1.44 (1.36–1.52)	1.13 (1.02–1.25)	1.25 (1.01–1.54)
Myocardial infarction	1	1.33 (1.16–1.53)	1.85 (1.53–2.25)	1.35 (0.85–2.15)	2.35 (1.32–4.18)
Stroke	1	1.24 (1.05–1.46)	1.96 (1.56–2.47)	1.64 (1.00–2.71)	1.20 (0.51–2.80)
Heart failure	1	1.32 (1.18–1.48)	1.89 (1.61–2.21)	1.16 (0.89–1.52)	1.32 (0.88–1.98)
ESRD	1	1.22 (0.80–1.86)	2.52 (1.58–4.02)	1.03 (0.78–1.35)	1.13 (0.80–1.59)
Doubling of serum creatinine level	1	1.10 (0.95–1.26)	1.77 (1.48–2.13)	1.05 (0.78–1.41)	1.40 (1.17–1.67)

Notes: A total of 23,296 people with diabetes mellitus and an estimated glomerular filtration rate lower than 60 mL/min/1.73 m² were identified within the Alberta Kidney Disease Network, Canada. Over the median follow-up period of 46 months, 3665 people died and 401 developed ESRD. The table highlights adjusted risk of adverse outcomes among people with stage 3 and stage 4 CKD, by baseline HbA_1c.¹²

Abbreviations: CKD, chronic kidney disease: ESRD, end-stage renal disease: HbA_1c, glycated hemoglobin.

Table 2 Use of conventional antidiabetic drugs in type 2 diabetic patients with chronic kidney disease

	eGFR >60 mL/min	eGFR 30–59 mL/min	eGFR <30 mL/min	Dialysis
Insulin	✓	✓	✓ dose reduction	✓ dose reduction
Metformin	✓	✓ caution	⊘	⊘
Sulfonylureas	✓	caution	caution	⊘
Metiglinides	✓	✓ caution	caution	⊘
Thiazolidinediones	✓	✓ caution	✓ caution	✓ caution
Alpha-glucosidase inhibitors	✓	✓	⊘	⊘

Note: ⊘, use not allowed.

Abbreviation: eGFR, estimated glomerular filtration rate.

Table 3 Dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists treatments in type 2 diabetic patients with chronic kidney disease

	Renal excretion	eGFR >60 mL/min	eGFR 30–59 mL/min	eGFR <30 mL/min	Dialysis
Sitagliptin	Predominant	100 mg	50 mg	25 mg	25 mg
Vildagliptin	Intermediate	100 mg	50 mg	50 mg	50 mg caution
Saxagliptin	Predominant	5 mg	2.5 mg	2.5 mg caution	2.5 mg caution
Linagliptin	Low	5 mg	5 mg	5 mg	?
Alogliptin	Predominant	12.5–25.0 mg	?	?	?
Exenatide	Predominant	5–10 μg/day	Caution	⊘	⊘
Liraglutide	No	0.6–1.8 mg/day	0.6–1.8 mg/day (caution)	⊘	⊘

Note: ?, unknown; ⊘, use not allowed.

Abbreviation: eGFR, estimated glomerular filtration rate.

Penno G Solini A Bonora E Renal Insufficiency And Cardiovascular Events (RIACE) Study Group Clinical significance of nonalbuminuric renal impairment in type 2 diabetes J Hypertens 2011 29 1802 1809 21738053

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Shurraw S Hemmelgarn B Lin M Alberta Kidney Disease Network Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study Arch Intern Med 2011 171 1920 1927 22123800

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