Table 2.

Dosing adjustment by CKD stage for meglitinides, α-glucosidase inhibitors, and DPP-4 inhibitors

Class	Drug	Dosing recommendation CKD stage 3, stage 4, or kidney transplant	Dosing recommendation, dialysis
Meglitinides	Repaglinide	No dose adjustment necessary	No dose adjustment necessary
		Initiate at 0.5 mg dose when GFR < 40 mL/minute/1.73 m2	Initiate at low dose Not available in Japan
	Nateglinide	Initiate at low dose, 60 mg meglitinides before each meal	Avoid
	Mitiglinide	No dose adjustment necessary Not available in the US	Initiate at low dose of 5 mg before each meal Not available in the US
α-glucosidase inhibitors	Acarbose	Not recommended in patients with sCr > 2 mg/dL in the US	Not recommended in the US
		No dose adjustment necessary in Japan	Caution recommended in Japan
	Miglitol	Not recommended in patients with sCr > 2 mg/dL in the US	Not recommended in the US
		Caution recommended in Japan	Caution recommended in Japan
	Voglibose	Not available in the US	Not recommended in the US
		No dose adjustment necessary in Japan	No dose adjustment necessary in Japan
DPP-4 inhibitors	Sitagliptin	Reduce dose by 50% (50 mg/day) when GFR < 50 mL/minute/1.73 m2 and ≥30 mL/minute/1.73 m2, and by 75% (25 mg/day) when GFR < 30 mL/minute/1.73 m2	Reduce dose by 75% (25 mg/day)
	Vildagliptin	Initiate at low dose	Initiate at low dose
		Not available in the US	Not available in the US
	Alogliptin	Reduce dose by 50% (12.5 mg/day) when GFR < 50 mL/minute/1.73 m2 and ≥30 mL/minute/1.73 m2, and by 75% (6.25 mg/day) when GFR < 30 mL/minute/1.73 m2 Not available in the US	Reduce dose by 75% (6.25 mg/day) Not available in the US

Note: Data from Abe et al.⁴⁹

Abbreviations: CKD, chronic kidney disease; DPP-4, dipeptidyl peptidase-4; GFR, glomerular filtration rate; sCR, serum creatinine.