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DPP-4 inhibitors
These compounds are covered in greater detail in Chapter 4; suffice
to say here that EU prescribing information for sitagliptin and vilda-
gliptin recommends that these agents should not be used in patients with
Stage 3-5 CKD (Table 1). 36 37 Saxagliptin can be used in these patients,
but a dose reduction is recommended (Table 1). In the EU, it is recom-
38
mended that none of these compounds be used in dialysis patients. 36-38
The equivalent information in the US recommends that sitagliptin, vilda-
gliptin and saxagliptin can be used in Stage 3-5 CKD with the appro-
priate dose adjustment. 39-41 Linagliptin, also covered in greater detail in
Chapter 4, is the only compound in this class that is primarily excreted
via bile and the gut, a characteristic that has important implications
for the potential management of T2DM patients with declining renal
function.
50
