Table 3.
Oral Diabetic Agents
| Medication Class | Mechanism of action | Medication | Usage in dialysis patients | Side effects |
|---|---|---|---|---|
|
| ||||
| Sulfonylureas |
|
1st generation: Acetohexamide Chlorpropamide Tolazamide Tolbutamide |
Avoid use of 1st generation agents in dialysis patients |
|
|
2nd generation: Glipizide Gliclazide Glimepiride Glyburide |
Glipizide is the agent of choice | |||
|
| ||||
| Meglitinides |
|
Repaglinide Nateglinide |
Dose reductions not specified, but no clear guidelines Avoid use in dialysis patients |
|
|
| ||||
| Biguanides |
|
Metformin | Avoid use in dialysis patients |
|
|
| ||||
| Thiazolidine-diones |
|
Rosiglitazone (soley PPAR-gamma agonist) Pioglitazone (also has PPAR-alpha effects) |
Restricted use by manufacturer Dose adjustment not required |
|
|
| ||||
| Dipeptidyl Peptidase-4 (DPP-4) Inhibitors |
|
Sitagliptin Saxagliptin Linagliptin |
Dose reduction by 75% Dose reduction to 25 mg po qday, given after dialysis Not well studied in dialysis patients |
|
|
| ||||
| Glucagon-like Peptide 1 Analogues |
|
Exenatide Liraglutide |
Avoid use in dialysis patients Avoid use in dialysis patients |
|
|
| ||||
| Amylin Analogues |
|
Pramlintide | Avoid use in dialysis patients |
|
|
| ||||
| Alpha-glucosidase inhibitors |
|
Acarbose Miglitol |
Avoid use in dialysis patients due to limited study |
|
|
| ||||
| Sodium-glucose cotransporter 2 inhibitors |
|
Canagliflozin Dapagliflozin |
Avoid use in dialysis patients |
|