The best diabetes medication if you have kidney disease can vary by the severity of your kidney damage. You may need to use one that does not require dose adjustment based on your kidney function.
When diabetes isn’t managed or controlled, it can lead to further complications. One complication is kidney damage. When there’s too much sugar in the blood, the kidneys will slowly get 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 most severe kidney damage. The most severe kidney damage is also known as kidney failure or end stage renal disease.
Nowadays, there are lots of medications for people with diabetes. Diabetes drugs that have shown to have evidence in reducing chronic kidney disease progression for people that have both diabetes and kidney disease are:
- canagliflozin
- empagliflozin
- dapagliflozin
- liraglutide
- semaglutide
- dulaglutide
People with kidney disease should have their medication at a safe and effective dose so the body can properly get rid of the drug. The proper dose can be determined by a healthcare professional.
Not all medications need to have their dose adjusted based on how well your kidneys are working. Antidiabetic medications that don’t need to have their dose adjusted for kidney function include:
- dulaglutide
- liraglutide
- semaglutide
- linagliptin
- insulin
Diabetes medication that should be avoided when there’s severe kidney damage includes:
- metformin
- ertugliflozin
- dapagliflozin
- canagliflozin
- empagliflozin
- exenatide
- lixisenatide
Fluid retention can be harmful because it can cause complications such as swelling, high blood pressure, heart problems, and more. When patients have chronic kidney disease, the kidneys aren’t working as well to remove excess fluids, so it’s important to recognize medications that have the potential for fluid retention.
Diabetes medications that should be avoided due to 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 chance of cardiovascular diseases. These conditions include:
- acute coronary syndromes
- history of myocardial infarction
- stable or unstable angina
- coronary artery disease
- stroke
- transient ischemic attack
- peripheral artery disease
Diabetes medications that are shown to have a proven benefit in patients with cardiovascular diseases and diabetes include:
- empagliflozin
- canagliflozin
- dulaglutide
- liraglutide
- semaglutide
Heart failure is a condition where the heart isn’t able to pump blood that well. Diabetes medications that are shown to have a proven benefit in patients with heart failure and diabetes are:
- empagliflozin
- canagliflozin
- dapagliflozin
- ertugliflozin
Patients with mild to severe kidney disease may use glimepiride but should consider starting at a low dose (1 milligram daily) and increasing the dose cautiously.
Patients with the most severe damage (kidney failure) should avoid using 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 manage your diabetes so it doesn’t lead to severe damage to your kidneys.
Working with a healthcare professional to determine the right medication or medications to manage both diabetes and kidney disease, as well as making appropriate lifestyle changes, are effective ways of managing both diabetes and kidney disease.
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 practices as a clinical pharmacist at Texas Arlington Memorial Hospital.