Last updated 23042019 CKD Stage 1 90 CKD

Last updated 23/04/2019 CKD Stage 1 (>90) CKD Stage 2 (60 -89) Repaglinide DPP-4 i No adjustment Saxagliptin No adjustment 2. 5 mg/day No adjustment Vildagliptin Avoid use 50 mg/day (Cr/Cl <50) No adjustment 12. 5 mg/day 6. 25 mg/day No adjustment† Dapagliflozin Avoid use if e. GFR < 45 ml/min Empagliflozin No adjustment† 10 mg/day† Avoid use if e. GFR < 45 ml/min Canagliflozin No adjustment† 100 mg/day† Avoid use if e. GFR < 45 ml/min Ertugliflozin Exenatide BID No adjustment Lixisenatide Avoid use if e. GFR < 45 ml/min No adjustment Careful use No adjustment Exenatide OW GLP-1 RA <4 Cr/Cl Lower dosages are recommended (see Sm. PC) Linagliptin SGLT-2 Avoid use No adjustment Sitagliptin Alogliptin CKD Stage 5 (<15) No adjustment Pioglitazone* e. GFR ‘cut-offs’ for glucose lowering therapies CKD Stage 4 (15 -29) No adjustment Glimepiride Other OADs CKD Stage 3 (30 -59) Avoid use (Cr Cl < 50) No adjustment Albiglutide** Avoid use Careful use Avoid use No adjustment Dulaglutide No adjustment Avoid use Liraglutide No adjustment Avoid use Semaglutide No adjustment Avoid use *pioglitazone should be avoided in dialysed patients and No dose adjustment is necessary in patients with impaired renal function (creatinine clearance > 4 ml/min); †Additional licence precautions; **Not launched – Final licence precautions not confirmed. CKD, chronic kidney disease; DPP-4 i, dipeptidyl peptidase-4 inhibitor; e. GFR, estimated glomerular filtration rate; GLP-1 RA, glucagon-like peptide-1 receptor agonist; OADs, oral antidiabetics; SGLT-2, sodium glucose co-transporter-2. Data derived from respective drug Sm. PCs. Available at: www. medicines. org. uk/EMC/medicine/ Last reviewed 23/04/2019 Indicated Restrictions apply Contraindicated