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Table 1. Recommendations for non-insulin hyperglycaemia drug therapy for patients
with moderate to severe CKD. Most of the content based on KDOQI clinical practice
guidelines and clinical practice recommendations for diabetes and chronic kidney
disease. For other sources refer to the table.
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Complication Hypoglycaemia Hypoglycaemia Hypoglycaemia Hypoglycaemia Hypoglycaemia Hypoglycaemia Hypoglycaemia Lactic acidosis Volume retention Volume retention Possible hepatic toxicity

Dialysis Avoid Avoid Avoid Avoid No dose adjustment Avoid Avoid No dose adjustment Avoid Avoid No dose adjustment No dose adjustment Avoid Avoid Avoid Not recommended Unknown Not recommended Not recommended Not recommended

GFR 50–70 ml/min/1.73 m 2 : ↓50% GFR <50 ml/min/1.73 m 2 : Avoid Initiate low dose: 60 mg Female: SCr >1.4 mg/dl Conservative dose escalation in Stage 3 CKD GFR <20 ml/min/1.73 m 2 : Unknown Dose reduced to 2.5 mg once daily (use with caution in Stage 4-5 CKD)

CKD Stage 3–5 Avoid Avoid Avoid No dose adjustment Avoid Low dose: 1 mg/day No dose adjustment Contraindicated: Male: SCr >1.5 mg/dl No dose adjustment No dose adjustment SCr >2 mg/dl: Avoid SCr >2 mg/dl: Avoid Not recommended No dose adjustment Not recommended Not recommended

Acetohexamide Chlorpropamide Tolbutamide Repaglinide Pioglitazone Rosiglitazone Liraglutide 33 Vildagliptin 37 Saxagliptin 38

Drug Tolazamide Glipizide Glyburide Glimepiride Nateglinide Metformin Acarbose Miglitol Exenatide 32 Pramlintide Sitagliptin 36

First-generation SU Second-generation α-Glucosidase in- Incretin mimetics/ Amylin analogue DPP-4 inhibitors

Class SU Meglitinides Biguanides TZDs hibitors analogues

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