CE/CME

Kidney Patients With Diabetes: Managing Their Medication

Clinician Reviews. 2014 February;24(2):34-42

References

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Because the vast majority of patients with chronic kidney disease (CKD) are diabetic and thus take hypoglycemic medications, knowledge of renal dosing for these medications, their mechanisms of action, and their safety profiles, as well as consideration of A1C goals, is vital for the practicing clinician. Management of the diabetic CKD patient, identified by stage of kidney disease, is outlined, with dosing regimens as determined by the glomerular filtration rate. Special attention is given to insulin management.

Diabetes is the most common cause of chronic kidney disease (CKD) throughout the world and leaves in its wake huge financial and social burdens.¹Diabetes has been the main cause of kidney failure in the United States for a number of years; as of 2012, diabetes became the most common cause of kidney failure in the world.²

The cost of caring for the rapidly increasing diabetes population in the US has been enormous. In 2012, the price tag for treating diabetes was $245 billion for medical care alone.³ The societal cost—loss in life years, loss of productivity caused by an increase in early retirement and disability, and burden of caregiving on families—is immeasurable.

In addition to CKD, diabetes is a major risk factor for heart disease and can lead to blindness and amputations. The rising incidence of diabetes has resulted in a new sense of urgency and has prompted the health care community to find new ways to reduce the burden on the patient, as well as encourage more aggressive research on halting progression of the disease, preventing end-stage kidney failure, and avoiding the need for dialysis.

Nearly two out of three (59%) adults in the US will be diagnosed with CKD stages 3 to 5 during their lifetimes.⁴ Some of this can be attributed to normal loss of kidney function associated with aging. However, much is due to the double burden of diabetes and hypertension.⁵ Patients with CKD require ongoing medical care, and much of it will be provided in primary care practices.⁶ This article discusses the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 staging guidelines and explains which oral and injectable diabetes medications are acceptable at each stage of CKD (as defined by the glomerular filtration rate [GFR]) and how to simplify dosing.

On the next page: Staging CKD >>