What is the recommended dose of Tenigliptin (Mitiglinide analogue) for a patient with Impaired renal function?

Teneligliptin Dosing in Impaired Renal Function

Teneligliptin does not require dose adjustment in patients with impaired renal function, including those with end-stage renal disease (ESRD) on dialysis. The standard dose of 20 mg once daily can be safely used regardless of renal function status. 1, 2

Pharmacokinetic Profile in Renal Impairment

• Teneligliptin has a favorable pharmacokinetic profile in patients with renal impairment, with no significant accumulation requiring dose adjustment 2
• Unlike many other DPP-4 inhibitors that require dose reduction in advanced CKD, teneligliptin is eliminated via both renal excretion and hepatic metabolism, allowing for consistent dosing across all stages of kidney disease 1
• Pharmacokinetic studies have demonstrated that mild, moderate, and severe renal impairment do not significantly affect the maximum plasma concentration (Cmax) of teneligliptin 2

Dosing Recommendations

• For patients with any level of renal impairment (eGFR <15 to 89 ml/min/1.73 m²), the standard dose of 20 mg once daily can be maintained 1, 2
• For patients on hemodialysis, no dose adjustment is required as dialysis does not significantly affect the efficacy or safety of teneligliptin 2, 3
• If glycemic control is inadequate with 20 mg daily, the dose can be increased to 40 mg daily regardless of renal function status 4

Efficacy in Renal Impairment

• Studies have shown that teneligliptin 20 mg once daily effectively improves glycemic control in patients with end-stage renal disease on hemodialysis 3
• In hemodialysis patients, teneligliptin has demonstrated significant reductions in blood glucose levels (36.7 mg/dl decrease) and glycated albumin (-3.1%) 3
• Teneligliptin appears to be more potent than voglibose 0.3 mg three times daily or vildagliptin 50 mg once daily in patients with ESRD 3

Safety Considerations

• No increased incidence of hypoglycemia has been observed in patients with renal impairment receiving teneligliptin 3, 5
• The safety profile remains consistent across different renal function groups, with no new adverse events emerging in patients with impaired renal function 2, 3
• Unlike some other antidiabetic medications that require careful monitoring or dose adjustment in CKD (such as metformin, sulfonylureas, or some GLP-1 RAs), teneligliptin maintains a favorable safety profile across all stages of kidney disease 6

Comparison with Other DPP-4 Inhibitors in CKD

• While most DPP-4 inhibitors require dose adjustment in advanced CKD, teneligliptin is one of the few that does not 6:
  • Sitagliptin: Requires dose reduction to 25 mg daily if eGFR <30 ml/min/1.73 m² 6
  • Saxagliptin: Requires dose reduction to 2.5 mg daily if eGFR ≤45 ml/min/1.73 m² 6
  • Alogliptin: Requires dose reduction to 6.25 mg daily if eGFR <30 ml/min/1.73 m² 6
  • Linagliptin: No dose adjustment required (similar to teneligliptin) 6

Clinical Implications

• The lack of need for dose adjustment makes teneligliptin a convenient option for patients with fluctuating renal function or those progressing through different stages of CKD 1, 2
• For healthcare providers managing diabetic patients with CKD, teneligliptin offers simplicity in prescribing without the need for frequent dose adjustments based on eGFR changes 2, 3
• This characteristic is particularly valuable in patients with advanced CKD or those on dialysis, where medication management is often complex 3