Treatment
16
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
Sodium-Glucose
Cotransporter 2
(SGLT2)
Inhibitors
Does not cause
hypoglycemia.
Empagliflozin
can reduce
cardiovascular
events and
progression of
CKD.
Volume depletion
adverse effects
more common in
older patients.
Canagliflozin may
increase fracture
risk; has also been
associated with
an increased risk
of toe and foot
amputations.
May rarely cause
ketoacidosis.
Canagliflozin:
eGFR 45–60
a
: 100 mg/d
eGFR <45
a
: avoid use
Dapagliflozin:
eGFR <60
a
: avoid use
Empagliflozin:
eGFR <45
a
: avoid use
Ertugliflozin:
eGFR <60
a
: avoid use
Canagliflozin and
dapagliflozin have been
associated with acute
kidney injury.
Empagliflozin and
canagliflozin can reduce
progression of CKD.
Empagliflozin
and canagliflozin
have been
demonstrated
to reduce
major adverse
cardiovascular
events and CHF.
Glucagon-
Like Peptide
1 Receptor
Agonists
Does not cause
hypoglycemia.
May cause GI side
effects.
Exenatide: eGFR <30
a
:
avoid use
Liraglutide, dulaglutide,
semaglutide: No dosage
adjustment needed.
Lixisenatide – avoid if
eGFR <15
a
Liraglutide and
semaglutide
have been
demonstrated
to reduce major
adverse CVD
events.
Bromocriptine May cause nausea.
Does not cause
hypoglycemia.
Use with caution.
Not studied in CKD.
Colesevelam May cause GI side
effects.
Does not cause
hypoglycemia.
No dosage adjustment
needed, but limited data
are available.
a
eGFR levels are all in mL/min/1.73 m
2
(cont'd)
