Diabetic nephropathy patients how to choose hypoglycemic drugs?2017-07-26 10:24
For diabetic nephropathy patients with chronic kidney disease how to choose hypoglycemic drugs? This is a matter of clinical concern for every diabetic doctor, and also a concern for diabetes patients.
Selection of hypoglycemic drugs
Metformin: metformin alone does not cause kidney damage. Metformin should be discontinued and re administered under the guidance of a specialist when the patient is suffering from other severe conditions. Due to the possibility of lactic acid acidosis, it should be discontinued when GFR reaches 30ml/min/1.73m2.
Pioglitazone: pioglitazone excretion mainly by parent and metabolites into bile, but if liver dysfunction, 15%-30% drug from the urine, there is no need to adjust the dose can be safely used for renal dysfunction and elderly patients. However, if there is a liquid retention, it should not continue to use.
Repaglinide repaglinide: mainly by the liver, less than 8% active metabolites excreted in the urine, not with renal dysfunction and increased renal function decreased in the case without dose adjustment. But beware of low blood sugar risk.
DPP-4 inhibitors: in general, GFR reduces the number of patients who need to adjust doses when chronic kidney disease progresses from 3 to 4, but Leigh Glenn Dean does not need to adjust.
Insulin: the exogenous insulin is mainly removed by the kidneys. As the renal function decreases, the dosage needs to be adjusted so as to avoid hypoglycemia.
Note: These are only opinions of some experts and individuals. Please refer to the latest drug instructions and the latest research progress when using clinical medication for patients or doctors.