15
Table 6. Medications Used to Treat Hyperglycemia and
Special Concerns with Use in Older Patients With
CKD and CVD
Medication
Class
Use in Older
Patients
Use in Patients
with CKD
Use in Patients
with CVD
iazolidinediones
(TZD)
Does not cause
hypoglycemia.
Can increase
fracture risk.
Can cause fluid
retention.
Can cause weight
gain.
No dosage adjustment
needed.
Can cause fluid
retention.
Can increase fractures.
Pioglitazone has
been shown to
reduce CVD
mortality. Can
cause fluid
retention with
potential to
worsen HF.
Alpha-
Glucosidase
Inhibitors
Does not cause
hypoglycemia.
GI side effects
may cause
nonadherence.
Avoid if serum creatinine
>2.0 mg/dL because of
lack of studies in such
patients.
Dipeptidyl
Peptidase – 4
(DPP4) Inhibitors
Does not cause
hypoglycemia.
Sitagliptin:
eGFR >50
a
: 100 mg/d
eGFR 30–50
a
: 50 mg/d
eGFR <30
a
: 25 mg/d
Saxagliptin:
eGFR >50
a
: 2.5 or 5
mg daily
eGFR ≤50
a
: 2.5 mg
daily
Alogliptin:
eGFR >60
a
: 25 mg daily
eGFR 30–60
a
: 12.5 mg
daily
eGFR <30
a
: 6.25 mg
daily
Linagliptin:
No dosage adjustment
needed.
Saxagliptin has
been shown to
increase the risk
of HF.
(cont'd)
