1. eGFR ‘cut-offs’ for glucose lowering therapies
Last updated 23/04/2019
CKD Stage 1 (>90)
CKD Stage 2 (60-89)
CKD Stage 3 (30-59)
CKD Stage 4 (15-29)
CKD Stage 5 (<15)
Glimepiride
No adjustment
Avoid use
Other
OADs
Repaglinide
No adjustment
Pioglitazone*
No adjustment
<4 Cr/Cl
Sitagliptin
No adjustment
Lower dosages are recommended (see SmPC)
Saxagliptin
No adjustment
2.5 mg/day
Avoid use
DPP-4i
Vildagliptin
No adjustment
50 mg/day (Cr/Cl <50)
eGFR ‘cut-offs’ for glucose lowering therapies
Alogliptin
No adjustment
12.5 mg/day
6.25 mg/day
Linagliptin
No adjustment
Dapagliflozin
No adjustment†
Avoid use if eGFR < 45 ml/min
Empagliflozin
No adjustment†
10 mg/day†
Avoid use if eGFR < 45 ml/min
SGLT-2
Canagliflozin
No adjustment†
100 mg/day†
Avoid use if eGFR < 45 ml/min
Ertugliflozin
No adjustment
Avoid use if eGFR < 45 ml/min
Exenatide BID
No adjustment
Careful use
Avoid use
Exenatide OW
No adjustment
Avoid use (Cr Cl < 50)
Renal impairment precludes use of several glucose-lowering medications or requires cautious dose reduction and increased monitoring2
Typically, drugs and active drug metabolites for which the kidney represents the major route of elimination (via glomerular excretion, tubular secretion or both) accumulate as kidney function is impaired3
For these drugs, a dose adjustment or an extended dose interval is usually needed in chronic kidney disease (CKD) patients in order to keep an optimal safety/efficacy profile3
Reducing the dose without altering dosing frequency has a higher risk of overdosing the drug (due to progressive accumulation), but assures continuous coverage3
References
Summary of Product Characteristics. Available at: [Accessed March 2015].
Glimepiride SmPC. Available at:
Prandin® SmPC. Available at:
Actos® SmPC. Available at:
Januvia® SmPC. Available at:
Vipidia® SmPC. Available at:
Trajenta® SmPC. Available at:
Forxiga® SmPC. Available at:
Invokana® SmPC. Available at:
Byetta® SmPC. Available at:
Bydureon® SmPC. Available at:
Lyxumia® SmPC. Available at:
Trulicity® SmPC. Available at:
Victoza® SmPC. Available at:
Bailey CJ and Day C. Diabetes therapies in renal impairment. Br J Diabetes Vasc Dis 2012;12:
Arnouts P, Bolignano D, Nistor I, et al. Glucose-lowering drugs in patients with chronic kidney disease: a narrative review on pharmacokinetic properties Nephrol Dial Transplant 2013;0:1–18.
Lixisenatide
No adjustment
Careful use
Avoid use
GLP-1 RA
Albiglutide**
No adjustment
Avoid use
Dulaglutide
No adjustment
Avoid use
Liraglutide
No adjustment
Avoid use
Semaglutide
No adjustment
Avoid use
*pioglitazone should be avoided in dialysed patients and No dose adjustment is necessary in patients with impaired renal function (creatinine clearance > 4 ml/min);
†Additional licence precautions; **Not launched – Final licence precautions not confirmed.
CKD, chronic kidney disease; DPP-4i, dipeptidyl peptidase-4 inhibitor; eGFR, estimated glomerular filtration rate; GLP-1 RA, glucagon-like peptide-1 receptor agonist; OADs, oral antidiabetics; SGLT-2, sodium glucose co-transporter-2.
Indicated
Restrictions apply
Contraindicated
Data derived from respective drug SmPCs. Available at: Last reviewed 23/04/2019