Diabetes Drugs for People with Kidney Disease

When diabetes is not managed or controlled, it can lead to further complications. One complication is kidney damage. When there is too much sugar in the blood, the kidneys slowly become damaged as they try to filter out the excess sugar.

Chronic kidney disease can be classified by the extent of your kidney damage. These classifications range from mild, mild to moderate, moderate to severe, severe, and then to the most severe kidney damage. The most serious kidney damage is also known as renal failure or end stage kidney disease.

Today there are many medicines for people with diabetes. Diabetes drugs that have been shown to have evidence for reducing the progression of chronic kidney disease in people with both diabetes and kidney disease include:

  • canagliflozin
  • empagliflozin
  • dapagliflozin
  • liraglutide
  • semaglutide
  • dulaglutide

People with kidney disease need to get their medication in a safe and effective dose so that the body can get rid of the drug properly. The correct dose can be determined by a healthcare professional.

Not all medications require dose adjustment based on how well your kidneys are working. Antidiabetics that do not require dose adjustment for kidney function include:

  • dulaglutide
  • liraglutide
  • semaglutide
  • linagliptin
  • insulin

Diabetes medications to avoid if there is severe kidney damage include:

  • metformin
  • ertugliflozin
  • dapagliflozin
  • canagliflozin
  • empagliflozin
  • exenatide
  • lixisenatide

Fluid retention can be harmful as it can cause complications such as swelling, high blood pressure, heart problems and more. When patients have chronic kidney disease, the kidneys don’t work as well to remove excess fluid, so it’s important to recognize medications that may retain fluid.

Diabetes medications that should be avoided because of the potential for fluid retention are pioglitazone and rosiglitazone.

Glyburide is generally not recommended in cases of chronic kidney disease.

Having diabetes is a risk factor that increases the risk of cardiovascular disease. These conditions include:

  • acute coronary syndromes
  • history of myocardial infarction
  • stable or unstable angina
  • coronary artery disease
  • heart attack
  • transient ischemic attack
  • peripheral vascular disease

Diabetes medications that have been shown to have a proven benefit in patients with cardiovascular disease and diabetes include:

  • empagliflozin
  • canagliflozin
  • dulaglutide
  • liraglutide
  • semaglutide

Heart failure is a condition in which the heart cannot pump blood very well. Diabetes medications that have been shown to have a proven benefit in patients with heart failure and diabetes include:

  • empagliflozin
  • canagliflozin
  • dapagliflozin
  • ertugliflozin

Patients with mild to severe kidney disease can take glimepiride but should consider starting with a low dose (1 milligrams per day) and increasing the dose cautiously.

Patients with the most severe damage (renal failure) should avoid taking glimepiride.

Managing your diet, weight, physical activity and smoking habits can have a positive impact on managing diabetes and protecting the kidneys.

One of the most common causes of chronic kidney disease is diabetes. It’s important to control your diabetes so it doesn’t cause serious damage to your kidneys.

Working with a health care professional to determine the right medication or drugs to treat both diabetes and kidney disease, as well as making the right lifestyle changes, are effective ways to treat both diabetes and kidney disease.


dr. Monica Kean

dr. Monica Kean is a clinical pharmacist with experience in hospital pharmacy and long-term care. She has experience helping patients in internal medicine, emergency medicine, and critical and hospice care. dr. Kean currently works as a clinical pharmacist at Texas Arlington Memorial Hospital.

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