Chronic Kidney Disease - Diabetes Flashcards
Dr. Covert
A CKD patient with diabetes has a GFR >20, what is the antidiabetic drug of choice?
SGLT2i
-until dialysis or they receive a kidney transplant (not studied in transplant patients)
-if patient drops below 20 -> it doesn’t have to be discontinued until transplant or dialysis
A CKD patient with diabetes has a GFR >30, what is the antidiabetic drug of choice?
Metformin
-if GFR drops below 30 -> consider a change
Which drug is used as an add-on drug in CKD patients with diabetes?
GLP-1
MOA of SGLT2i
1st line
Blocks reabsorption of Glucose
-Dapagliflozin “Gl flows into the urine” (Farxiga)
-Empagliflozin (Jardiance)
Benefits of SGLT2i
-Renal - patients with CKD
-Cardiovascular - patients with heart failure
-antidiabetic
-oral
Side effects of SGLT2i
-UTI infection
-dehydration (concentrating glucose in the urine causes a diuretic effect)
-risk for limb amputation with Canagliflozin
MOA for Metformin
1st line
-drops glucose production in the liver
-reduces the absorption of glucose in the intestine
-increases the sensitivity of insulin
Benefits of Metformin
-Antidiabetic
-Cardiovascular disease reduction
-oral
Side effects of Metformin
-generally tolerated well
-GI upset (common)
-lactic acidosis (rare)
When to consider Metformin discontinuation
when GFR drops below 20
MOA of GLP-1 agonists
-increase insulin secretion
-reduce glucagon secretion
-increase beta-cell growth in the pancreas (produce insulin)
-slows gastric emptying (promotes weight loss)
Benefits of GLP-1 agonists
-renal disease reduction
-Cardiovascular disease reduction
What are the GLP-1 agonists recommended by the guidelines?
-Liraglutide
-Semaglutide (inj)
-dulaglutide
Side effects of GLP-1 agonists
GI upset (due to slowing of the GI tract)
Add on medications - Insulin
-no cardiovascular or renal benefit
long T1/2
no guidance of adjustments (as renal function worsens, the needed dose decreases)
