Peter Ponťuch
The dose adjustment of some antidiabetic agents in type 2 diabetic patients with diabetic nephropathy, or non-diabetic kidney disease with decreased glomerular filtration rate (GFR) is required. The value of GFR could be calculated using following formulas: MDRD-4, Cockcroft-Gault, and CKD-EPI. Antidiabetic agents with short half-time of elimination, transformation in liver into inactive metabolites and low proportion of renal excretion are indicated for diabetic patients with GFR reduction. They are sulfonylurea derivates gluquidon and glipizide, glitazones and linagliptin belonging to new antidiabetic agents targeting incretin system. Note that metformin increases a risk of lactate acidosis and hypoglycaemia in diabetic patients with moderate GFR reduction. By taking into account the decreased GFR, dose of antidiabetic agents is adjusted by a diabetologist.