From the Guidelines
Alogliptin is suitable for patients with End-Stage Renal Disease (ESRD), but requires dose adjustment based on kidney function, as indicated in the most recent guidelines 1. The dose adjustment is necessary because alogliptin is primarily eliminated by the kidneys, and patients with ESRD have significantly reduced ability to clear the drug from their system.
- The medication can be administered without regard to the timing of dialysis.
- Alogliptin remains an effective option for glycemic control in ESRD patients with type 2 diabetes, as it works by inhibiting DPP-4 enzymes to increase incretin hormones, which help regulate blood glucose levels.
- Alogliptin has a relatively favorable side effect profile in this population and does not cause hypoglycemia when used as monotherapy, making it a reasonable choice for diabetes management in patients with severe renal impairment. Some key considerations for the use of alogliptin in ESRD patients include:
- Monitoring kidney function and adjusting the dose accordingly
- Being aware of the potential for pancreatitis, a rare but serious side effect of DPP-4 inhibitors
- Considering the use of other medications that may be more suitable for patients with ESRD, such as GLP-1 receptor agonists or SGLT2 inhibitors, which have been shown to have beneficial effects on cardiovascular and kidney outcomes 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.2 Patients with Renal Impairment The dose of alogliptin tablets is 6. 25 mg once daily for patients with severe renal impairment (CrCl ≥15 to <30 mL/min) or with end-stage renal disease (ESRD) (CrCl <15 mL/min or requiring hemodialysis).
Alogliptin can be used in ESRD patients, but the dose should be adjusted to 6.25 mg once daily. It is recommended to assess renal function prior to initiation of alogliptin therapy and periodically thereafter 2.
From the Research
Alogliptin Use in ESRD Patients
There are no direct research papers to assist in answering this question about the use of alogliptin in patients with End-Stage Renal Disease (ESRD).
General Considerations for ESRD Patients
- ESRD patients are at increased risk of hypoglycemia due to diminished gluconeogenesis, reduced insulin clearance, and improved insulin sensitivity following initiation of renal replacement therapy 3.
- Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication 4.
- The decision to initiate dialysis is best made through shared decision-making, and controlling blood pressure in patients receiving dialysis improves mortality 4.
- Patients with ESRD should be monitored for signs of protein-energy wasting and malnutrition 4.
Medication Considerations
- Metformin may be used with caution in a particular group of ESRD patients who are on automated peritoneal dialysis (APD), as it allows better diabetic control with significant reduction of BMI 5.
- The use of oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease requires careful consideration of pharmacokinetic properties and dosing 6.
- Hypoglycemia is common in patients with ESRD, and factors associated with a higher risk of hypoglycemia include no prior diagnosis of diabetes, no use of diabetes medication prior to admission, and a lower pretreatment glucose level 7.