Qtern and Renal dysfunction

The glucose lowering effects of SGLT-2 inhibitors is decreased in patients with worsening renal function. Additionally, SGLT-2 inhibitors increase serum creatinine and decrease eGFR. The elderly and patients with moderate renal impairment are at increased risk of further renal dysfunction. Renal function should be evaluated before treatment initiation and monitored regularly in these patients. The use of SGLT-2 inhibitors in patients with severe renal impairment, end stage renal dysfunction (ESRD), or undergoing dialysis is contraindicated. Based on its mechanism of action, SGLT-2 inhibitors are not expected to be effective in patients with this level of renal dysfunction.

It is recommended to assess renal function prior to initiating treatment with DPP-4 inhibitors. Patients with moderate to severe renal insufficiency and end stage renal dysfunction will require a dose adjustment. Linagliptin will not require a dose adjustment per manufacturer's information. Additionally, there have been postmarketing reports of worsening renal function in some patients with renal insufficiency taking sitagliptin at inappropriate doses. However, sitagliptin has not been found to be nephrotoxic in preclinical studies or clinical trials at appropriate doses.