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Update on oral hypoglycemic agents use in CKD

Update on oral hypoglycemic agents use in CKD. ZT-Nephrologist. Inappropriate Prescribing in Chronic Kidney Disease. We can reduce inappropriate prescribing rate!!!!!!!!!!!!. Metformin. Mechanism and it’s beneficial effects on CVD.

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Update on oral hypoglycemic agents use in CKD

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  1. Update on oral hypoglycemic agents use in CKD ZT-Nephrologist

  2. Inappropriate Prescribing in Chronic Kidney Disease We can reduce inappropriate prescribing rate!!!!!!!!!!!!

  3. Metformin Mechanism and it’s beneficial effects on CVD

  4. Patients who stopped or inappropriately using metformin after decline in their eGFR

  5. FDA: guidelines for the use of metformin in ckd • Metformin is contraindicated in “renal disease or renal dysfunction (eg, as suggested by serum creatinine levels ≥1.5 mg/dL [males], ≥1.4 mg/dL [females]) or abnormal creatinine clearance (CrCl).” • Metformin “should not be initiated in patients_80years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced.”

  6. General Rules: Use of Metformin in CKD Lipska et al Diabetic Care 2011

  7. Inzuchi JAMA 2014

  8. Inzuchi JAMA 2014

  9. Metformin use and risk of lactic acidosis in people with diabetes with and without renal impairment: a cohort study in Denmark and the UK Risk of lactic acidosis was higher in metformin users than in other glucose-lowering agent users, and increased with decreasing eGFR, although this could be attributable to surveillance bias; however, diagnosed lactic acidosis was rare and can occur regardless of renal function. Jick et al Diabetic Medicine 2017

  10. A dosing algorithm for metformin based on the relationships between exposure and renal clearance of metformin in patients with varying degrees of kidney function Interesting study. But use of metformin isn’t recommended in CKD IV patients in Myanmar. Duon et al Eur J Clin Pharmacol 2017

  11. A dosing algorithm for metformin based on the relationships between exposure and renal clearance of metformin in patients with varying degrees of kidney function Interesting study. But use of metformin isn’t recommended in CKD IV patients in Myanmar. Duon et al Eur J Clin Pharmacol 2017

  12. Extending Metformin Use in Diabetic Kidney Disease: A Pharmacokinetic Study in Stage 4 Diabetic Nephropathy Interesting study. But use of metformin isn’t recommended in CKD IV patients in Myanmar. Dissanayake et al Kidney Int Rep 2017

  13. Diabetic hemodialysis patients with hemoglobin A1c (HbA1c) levels below 6.5% and over 8.0% face a higher mortality risk in Japan.

  14. The most recent OHA in CKD

  15. DPP-IV inhbitors

  16. Haemodialysis international 2017

  17. GLP-1 Receptor Agonist

  18. SGLT-2 inhibitors

  19. Xu et al PeerJ 2017

  20. Neal et al NEJM 2017

  21. Neal et al NEJM 2017

  22. Therapeutic algorithm in patient with type 2 diabetes and CKD Lullo et al Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2016

  23. Watch out for updated guidelines Guidelines 1. 2. 3.

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