Oral Pharmacotherapy for Patients with Diabetic Kidney Disease: An Update

摘要

Diabetes mellitus is the leading cause of chronic kidney disease (CKD) that usually progresses to end stage renal disease (ESRD) requiring dialysis or kidney transplantation. CKD is also associated with cardiovascular morbidity and mortality. Optimum control of blood sugar is the most important intervention to prevent or delay the progression of early stage diabetic kidney disease (DKD) to ESRD and to prevent cardiovascular events. Currently there are few antidiabetic drugs that are totally safe in a patient with DKD. The role of this review paper is to explore the safety and renoprotective effect of oral antidiabetic drugs used in patients with DKD. Traditionally, insulin has been considered the ideal choice for treating diabetic patients with CKD. Recently, new oral drug options have become good alternatives in the management of DKD. Sodium-glucose cotransporter 2 (SGLT2) inhibitors (dapagliflozin, canagliflozin, and empagliflozin) and certain dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, alogliptin, and linagliptin) have been reported to improve renal outcomes by reducing the amount of albuminuria and preventing GFR loss in patients with type 2 diabetes. The renoprotective effect along with reduction in HbA1c levels, indicates the potential therapeutic effect of SGLT2 inhibitors and some DPP4 inhibitors in DKD.