From the Guidelines
For patients with Chronic Kidney Disease (CKD) stage 3 and impaired renal function, the recommended dose of sitagliptin (Januvia) is 25 mg once daily, as the maximum dose for eGFR 30 to 50 mL/min/1.73 m² is 25 mg daily. This dose adjustment is based on the medication's labeling recommendations, which take into account the patient's reduced kidney function 1. Sitagliptin is primarily eliminated through the kidneys, and reduced kidney function leads to higher blood levels of the medication. CKD stage 3 corresponds to an estimated glomerular filtration rate (eGFR) of 30-59 mL/min/1.73m². The dose adjustment is necessary to minimize the risk of adverse effects while still effectively lowering blood glucose. Some key points to consider when dosing sitagliptin in patients with CKD stage 3 include:
- The medication's efficacy in lowering blood glucose is maintained even in patients with renal impairment, as it works by inhibiting DPP-4 enzymes to increase incretin hormones that stimulate insulin release and reduce glucagon secretion.
- Regular monitoring of kidney function is important while on this medication, as changes in kidney function may require further dose adjustments 1.
- Other medications, such as saxagliptin and alogliptin, also have dose adjustments for patients with CKD, but sitagliptin's recommended dose for CKD stage 3 is clearly outlined as 25 mg once daily 1.
From the Research
Sitagliptin Dose Adjustment for CKD3
- The recommended dose of sitagliptin for patients with Chronic Kidney Disease (CKD) stage 3 is 50 mg once daily 2, 3, 4.
- This dose adjustment is necessary to achieve plasma concentrations similar to those observed in patients with normal renal function treated with 100 mg sitagliptin once daily 3.
- Patients with severe renal insufficiency (CKD stage 4 or 5) require a further dose reduction to 25 mg once daily 2, 3, 4.
Rationale for Dose Adjustment
- Sitagliptin is primarily renally excreted, and its clearance decreases with declining renal function 3, 5.
- The dose adjustment is intended to minimize the risk of adverse effects, such as hypoglycemia, while maintaining the efficacy of sitagliptin in improving glycemic control 3, 4.
Efficacy and Safety of Sitagliptin in CKD3
- Sitagliptin has been shown to be effective in improving glycemic control in patients with CKD stage 3, with a similar efficacy profile to glipizide 4.
- The safety profile of sitagliptin in patients with CKD stage 3 is generally favorable, with a lower incidence of symptomatic hypoglycemia and weight gain compared to glipizide 4.
- However, patients with CKD stage 3 are at higher risk of diabetes-associated complications, such as diabetic eye disease, diabetic neuropathy, and renal failure, and require close monitoring 6.