Current and emerging antiglycaemic pharmacological therapies: The renal perspective

Abstract

Diabetes mellitus and chronic kidney disease are two major global epidemics, with a significant overlap of patients with concomitant problems. Therapeutic guidelines for the treatment of diabetes mellitus are continuously updated to reflect the growing armamentarium of antiglycaemic agents at the disposal of clinicians. However, they rarely focus on the significant caveats and limitations associated with pharmacological delivery of glucose-lowering treatment in the context of advancing kidney disease or in the presence of a renal allograft. Proposed consensus algorithms for the treatment of hyperglycaemia may not be appropriate for individuals with coexisting renal disease and it is imperative to ensure nephrologists maintain a thorough understanding of the limitations of antiglycaemic treatments in the presence of renal insufficiency or a renal allograft. The purpose of this review is to highlight the range of glucose-lowering therapies at the disposal of the clinician, both currently available and in development, and discuss the advantages and disadvantages of these pharmacological agents from a renal perspective. A tailored and individualized approach to treatment of diabetes mellitus in the context of renal disease is essential to maintain optimum care and this article should act as a supplement to existing guidelines and treatment algorithms. The use of different antiglycaemic agents for diabetes mellitus in advancing kidney disease and in renal transplantation is reviewed. The benefits and possible side effects of conventional and new therapies including biguanides, sulphonylurea, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides, GLP-1 agonists, DPP-4 inhibitors and insulin are discussed. © 2011 Asian Pacific Society of Nephrology.