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Use of Oral Glycemic Drugs in CKD
The use of oral glycemic drugs in patients with Chronic Kidney Disease (CKD) requires careful consideration due to altered drug metabolism and excretion associated with kidney dysfunction. Metformin, often the first-line treatment for type 2 diabetes, may be used with caution in mild to moderate CKD but is contraindicated in advanced stages due to the risk of lactic acidosis. Sulfonylureas, except for gliclazide and glimepiride, are generally avoided in CKD because of the prolonged hypoglycemia risk. DPP-4 inhibitors are safer options but may require dose adjustments based on renal function. SGLT2 inhibitors, beneficial for their cardiovascular and renal protective effects, are increasingly recommended, though some are contraindicated in severe CKD. GLP-1 receptor agonists offer a safer profile for CKD patients, with liraglutide and semaglutide being viable options. Ultimately, individualized treatment, frequent monitoring, and adjustments of oral hypoglycemic agents are crucial in managing diabetes in CKD patients.
About the Speaker
Dr. Adarsh K.S.
Consultant in Dept of Endocrinology, Manipal Hospitals,Bangalore
Adarsh K S is a distinguished Consultant in the Department of Endocrinology at Manipal Hospitals in Bangalore, with an extensive educational background comprising an MBBS, MD in Medicine, and a DM in Endocrinology from some of India's prestigious institutes.
Upcoming Case Discussions
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Hyperlipidemia: From Diagnosis to Treatment
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Acne: Disorders and Treatment Approaches
Acne is a common dermatological condition caused by clogged pores, excess sebum production, bacterial growth, and inflammation. It can manifest as blackheads, whiteheads, papules, pustules, or cysts, often leading to scarring if untreated. Various factors, including hormonal changes, diet, stress, and genetics, influence its severity. Treatment approaches range from topical and oral medications, such as retinoids, antibiotics, and hormonal therapy, to advanced procedures like chemical peels and laser therapy. A personalized skincare regimen, along with lifestyle modifications, plays a crucial role in managing and preventing acne.
Lung Ultrasound in Acute Respiratory Failure
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Gallstone Disease & Cholecystitis: When to Operate?
iGallstone disease and cholecystitis are common conditions requiring careful evaluation to determine the need for surgery. Symptomatic gallstones causing recurrent pain, nausea, or complications like cholecystitis often necessitate cholecystectomy. Acute cholecystitis, characterized by inflammation, fever, and right upper quadrant pain, typically requires early surgical intervention to prevent complications like perforation or sepsis. In high-risk patients, conservative management with antibiotics and drainage may be considered. Elective surgery is recommended for asymptomatic patients with high-risk factors, such as large gallstones or gallbladder polyps, to prevent future complications.
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Dr. Adarsh K.S. 's Talks on Assimilate
- 30th-January-2024, TIME : 5:00PM - 6:00PM
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The use of oral glycemic drugs in patients with Chronic Kidney Disease (CKD) requires careful consideration due to altered drug metabolism and excretion associated with kidney dysfunction. Metformin, often the first-line treatment for type 2 diabetes, may be used with caution in mild to moderate CKD but is contraindicated in advanced stages due to the risk of lactic acidosis. Sulfonylureas, except for gliclazide and glimepiride, are generally avoided in CKD because of the prolonged hypoglycemia risk. DPP-4 inhibitors are safer options but may require dose adjustments based on renal function. SGLT2 inhibitors, beneficial for their cardiovascular and renal protective effects, are increasingly recommended, though some are contraindicated in severe CKD. GLP-1 receptor agonists offer a safer profile for CKD patients, with liraglutide and semaglutide being viable options. Ultimately, individualized treatment, frequent monitoring, and adjustments of oral hypoglycemic agents are crucial in managing diabetes in CKD patients.