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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.

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Dr. Adarsh K.S.  Profile Image

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.

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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.