. Author manuscript; available in PMC: 2014 Dec 2.

Published in final edited form as: Endocrinol Metab Clin North Am. 2013 Aug 1;42(4):789–808. doi: 10.1016/j.ecl.2013.06.002

Table 1.

Dosage of drugs used to manage hyperglycemia in patients with diabetes and CKD/DKD. Adapted from (84, 86-90)

Drug Class	Drug	Major Action	Dosing recommendation in CKD	Dosing recommendation in dialysis
*Sulfonylureas*	Glipizide	Insulin Scretagouge	No dose adjustment required	No dose adjustment required
	Glimepiride	Insulin Scretagouge	Initiate at 1 mg/day and titrate slowly	Avoid
	Glyburide	Insulin scretagouge	Not recommended	Not recommended
*Alpha Glucosidase inhibitors*	Acarbose	Slow carbohydrate absorption	Not recommended in sCr>2 mg/dL	Not recommended
*Alpha Glucosidase inhibitors*	Miglitol	Slow carbohydrate absorption	Not recommended if sCr> 2mg/dL	Not recommended
*-Meglitinides*	Repaglinide	Insulin Scretagouge	Initiate at a lower dose 0.5mg before each meal if GFR< 40	Use not studied
*-Meglitinides*	Nateglinide	Insulin scretagouge	Initiate at a low dose 60 mg before each meal	Avoid
*Biguanides*	Metformin	Liver insulin sensitizer	Contraindicated if sCr >= 1.5 mg/dL in men, and >= 1.4 mg/dL in women	Not recommended
*Thaizolidinediones*	Rosiglitazone	Peripheral insulin sensitizer	No dose adjustment	No dose adjustment
*Thaizolidinediones*	Pioglitazone	Peripheral insulin sensitizer	No dose adjustment	No dose adjustment
*Incretin Minmetics*	Exenatide	Improved insulin secretion	GFR > 50 no dose adjustment GFR 30-50 cautious use, but no dose adjustment suggested GFR < 30 use not recommended	Use not recommended
*Incretin Minmetics*	Liraglutide	Improved insulin secretion	No dose adjustment	No dose adjustment
*DPP-4 inhibitors*	Sitagliptin	Improved insulin secretion	GFR > 50 no dose adjustment, use 100mg/day GFR 30- 50 use 50 mg/day GFR < 30 use 25 mg/day	Use 25 mg/day
	Alogliptin	Improved insulin secretion	GFR > 50 no dose adjustment GFR 50-30 use 12.5 mg/day GFR < 30 use 6.25 mg/day	Use 6.25 mg/day
	Linagliptin	Improved insulin secretion	No dose adjustment	No dose adjustment
	Saxagliptin	Improved insulin secretion	GFR> 50- no dose adjustment GFR< 50- use 2.5 mg/day	Use 2.5 mg/day
*Amyin Analog*	Pramlintide	Increased satiety and decreased glucagon	GFR > 20 no dose adjustment	Lacks clinical data
*Sodium Glucose cotransporter 2 inhibitors*	Canagliflozin	Glucuresis	GFR ≥ 60 No dose adjustment ( use 100- 300mg daily) GFR 45-60 (Maximum dose 100 mg/ day) GFR 30- 45 Use not recommended GFR < 30 Contraindicated	Contraindicated