The use of dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes & chronic kidney disease.
Polly A Bittle
PMID 28225432WHAT IT FOUND
DPP-4 inhibitors lowered blood sugar in diabetes with kidney disease without more low sugar or weight gain, but kidney function findings were mixed.
Sitagliptin, saxagliptin, and alogliptin need dose changes; linagliptin does not.
Key findings
01In people with diabetes and moderate-to-severe chronic kidney disease, DPP-4 inhibitor monotherapy reduced HbA1C by 0.52% versus placebo or no treatment and was not associated with increased hypoglycemia or weight gain.
02Sitagliptin, saxagliptin, and alogliptin require dose adjustment in moderate-to-severe renal impairment, but linagliptin does not require dose adjustment for any level of kidney function.
03DPP-4 inhibitors have warnings for acute pancreatitis, hypersensitivity reactions, severe and disabling joint pain, and bullous pemphigoid; saxagliptin and alogliptin need monitoring for heart failure.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This is a narrative review, not a new trial, and it does not report how studies were selected. Kidney outcome evidence is mixed: sitagliptin had slightly lower eGFR than placebo, and linagliptin did not significantly change UACR in MARLINA-T2D. Patients with diabetic kidney disease are often excluded from clinical studies, so the evidence may not fully represent them. The review focuses on glucose control and safety, so it does not establish that every DPP-4 inhibitor has the same kidney effect.
The easy way to misread this
Do not read this as proof that DPP-4 inhibitors protect kidney function. The review reports glucose lowering and safety, but sitagliptin had slightly lower eGFR than placebo, and linagliptin did not significantly change UACR in MARLINA-T2D.