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Antidiabetika bei Patienten mit Niereninsuffizienz

Antidiabetic drugs and patients with renal impairment

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Hintergrund

Viele Antidiabetika müssen bei Niereninsuffizienz angepasst werden.

Fragestellung

Dosisanpassung von Antidiabetika an die Nierenfunktion, spezielle Risiken, Gegenanzeigen.

Material und Methode

Darstellung und Bewertung von aktuellen Empfehlungen, basierend auf Angaben in den deutschen Fachinformationen und publizierten Artikeln aus der wissenschaftlichen Literatur.

Ergebnisse

Die Auswahl eines Antidiabetikums sollte nach individueller Abwägung von erwarteten Wirkungen und möglichen Risiken erfolgen. Metformin ist bei Niereninsuffizienz kontraindiziert. Pioglitazon ist möglich, es sind aber zahlreiche Risiken zu bedenken. Die Wirkungen von Gliquidon und Repaglinid gelten im Wesentlichen als nierenunabhängig. GLP („glucagon-like peptide“)-1-Analoga sollten bei hochgradiger Niereninsuffizienz vermieden werden, Dipeptidylpeptidase (DPP)-4-Hemmer sind (ggf. mit Dosisanpassung) möglich. SGLT2 („sodium-glucose linked transporter 2“)-Hemmer sind bei Niereninsuffizienz kaum wirksam, Alpha-Glukosidase-Hemmer sind bei hochgradiger Niereninsuffizienz kontraindiziert.

Schlussfolgerungen

Auch bei Patienten mit höhergradiger Niereninsuffizienz ist eine Behandlung mit oralen Antidiabetika möglich. Empfohlene Dosisanpassungen und Kontraindikationen sind jedoch zu berücksichtigen.

Abstract

Background

Many antidiabetic drugs have to be adjusted for administration to patients with renal impairment.

Objectives

Drug dose adjustment of antidiabetic drugs to renal function, specific risks and contraindications.

Material and methods

Review of current recommendations based on the German summary of product characteristics and published articles from the scientific literature.

Results

The selection of an antidiabetic drug should be made after individual consideration of expected benefits and potential risks. Metformin is contraindicated in patients with renal impairment. Pioglitazone may be used but a number of potential risks have to be considered. Gliquidone and repaglinide are considered as being kidney-independent. Glucagon-like peptide 1 (GLP-1) analogues should be avoided in patients with severe renal impairment but dipeptidyl peptidase 4 (DPP-4) inhibitors may be used (with dose adjustment). Sodium-glucose linked transporter 2 (SGLT2) inhibitors are inefficient in patients with renal impairment and alpha glucosidase inhibitors are contraindicated in cases of severe renal impairment.

Conclusion

Oral antidiabetic drugs can also be prescribed for patients with renal impairment but recommended drug dose adjustments and contraindications must be considered.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Czock erhielt Reisekostenerstattungen sowie Honorare für Vorträge und/oder Beratertätigkeit (Data Safety Monitoring Board) von Sanofi-Aventis, Bayer Vital GmbH und Novartis, die nicht im Zusammenhang mit dem Thema des vorliegenden Artikels standen.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Medizinische Klinik, Abt. Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland

    D. Czock

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Correspondence to D. Czock.

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Czock, D. Antidiabetika bei Patienten mit Niereninsuffizienz. Nephrologe 9, 433–441 (2014). https://doi.org/10.1007/s11560-014-0879-8

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