From the Guidelines
The best treatment approach for an 84-year-old male with diabetes and chronic renal failure is to use SGLT2 inhibitors such as canagliflozin or dapagliflozin, which may offer renoprotective benefits, at a maximum dose of 100 mg daily for canagliflozin or 10 mg daily for dapagliflozin, as recommended by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) consensus report 1. The selection of SGLT2 inhibitors should be based on the patient's estimated glomerular filtration rate (eGFR) and individualized glycemic targets.
- For patients with an eGFR of 30-44 mL/min/1.73 m2, canagliflozin or dapagliflozin can be used at the recommended doses.
- For patients with an eGFR of 15-29 mL/min/1.73 m2, initiation of SGLT2 inhibitors is not recommended, but canagliflozin or dapagliflozin can be continued at the recommended doses if already tolerated.
- For patients with an eGFR <15 mL/min/1.73 m2, SGLT2 inhibitors should not be initiated, and alternative treatments should be considered. In addition to SGLT2 inhibitors, other treatment approaches such as blood pressure control with ACE inhibitors or ARBs, dietary modifications, and regular monitoring of kidney function and blood glucose are crucial to balance glycemic control and minimize medication-related complications 1. Key considerations include:
- Blood pressure control: ACE inhibitors or ARBs at reduced doses (e.g., lisinopril 2.5-5 mg daily or losartan 25-50 mg daily) to slow kidney disease progression.
- Dietary modifications: protein restriction (0.8 g/kg/day), potassium and phosphorus restriction, and sodium limitation (less than 2 g daily).
- Regular monitoring: kidney function (every 3-6 months), electrolytes, and blood glucose.
- Target HbA1c: less restrictive (7-8%) than for younger patients to avoid hypoglycemia.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Approach for Diabetes and Chronic Renal Failure
The treatment approach for an 84-year-old male patient with diabetes and chronic renal failure involves the use of SGLT2 inhibitors, which have been shown to slow disease progression and reduce the risk of cardiovascular disease 2, 3.
SGLT2 Inhibitors for Chronic Renal Failure
Some SGLT2 inhibitors that can be used in this patient population include:
- Canagliflozin: shown to reduce the risk of CKD progression in patients with type 2 diabetes 2
- Dapagliflozin: shown to reduce the risk of CKD progression in patients with or without type 2 diabetes 2
- Empagliflozin: shown to improve CV and renal outcomes in patients with type 2 diabetes, especially in those with prior CV events, heart failure, or chronic kidney disease 3, 4
Considerations for Treatment
When treating an 84-year-old male patient with diabetes and chronic renal failure, it is essential to consider the patient's individual needs and medical history. The patient's renal function, glycemic control, and cardiovascular risk factors should be carefully evaluated to determine the best treatment approach 5, 6.
Key Points to Consider
- SGLT2 inhibitors can be used to slow disease progression and reduce the risk of cardiovascular disease in patients with diabetes and chronic renal failure
- Canagliflozin, dapagliflozin, and empagliflozin are SGLT2 inhibitors that have been shown to be effective in this patient population
- Individualized treatment with SGLT2 inhibitors represents a promising therapeutic option for patients with diabetic and nondiabetic CKD 2
- Close collaboration between the diabetologist and the nephrologist is crucial for the management of patients with hyperglycemia and chronic renal failure 5