Hypoglycemia and possibilities of oral therapy of type 2 diabetes in patients with chronic kidney disease

• Leonid Yu. Morgunov

Abstract

Diabetic nephropathy is the main cause of end-stage renal disease. The appearance of diabetic nephropathy is a marker of multisystem failure and has an unfavorable prognostic value. Patients with renal failure have higher morbidity, mortality and risk of hypoglycemia. The effect of hypoglycemia on mortality in patients with CKD is still unclear. In patients with type 2 diabetes, chronic kidney disease is associated with an increased risk of hypoglycemia, microvascular events and death, so the assessment of the effect of severe hypoglycemia on renal function is important. Adequate glycemic control is necessary to prevent the progression of chronic kidney disease, and careful management of metabolic disorders in diabetic nephropathy will contribute to better control of diabetes mellitus. The goals of glycemic control in patients with type 2 diabetes mellitus and chronic kidney disease should be individualized according to account life expectancy, renal function, the risk of hypoglycemia and comorbidities. Renal failure in patients with type 2 diabetes restricts the use of oral hypoglycemic therapy. This is primarily due to the risk of hypoglycemia. Chronic renal failure due to type 2 diabetes is a risk factor for the progression of diabetic nephropathy, the development of cardiovascular complications and mortality. An extensive literature search to analyze the effect of chronic renal failure on the pharmacokinetics of hypoglycemic drugs showed that for safety reasons, the daily dose of hypoglycemic drugs received by the patient should be reduced in accordance with the glomerular filtration rate or the drug should be completely canceled in the presence of severe chronic kidney disease. This review discusses the possibility of using hypoglycemic therapy for renal failure in patients with type 2 diabetes, in particular, мetformin and dipeptidylpeptidase-4 inhibitors.

Keywords:type 2 diabetes, chronic kidney disease, renal failure, hypoglycemia

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