Teneligliptin Dosing in Patients with Impaired Renal Function
Teneligliptin can be administered at the standard dose of 20 mg once daily without dose adjustment in patients with any degree of renal impairment, including end-stage renal disease (ESRD) requiring dialysis. 1
Pharmacokinetic Considerations
- Teneligliptin maintains consistent pharmacokinetics across all stages of renal impairment (mild, moderate, severe, and ESRD), making it suitable for patients with compromised kidney function 2
- Unlike many other DPP-4 inhibitors, teneligliptin does not require dose adjustment as renal function declines 1
- Dialysis does not significantly affect the efficacy or safety profile of teneligliptin, allowing for consistent dosing in patients undergoing hemodialysis 2
Comparison with Other DPP-4 Inhibitors
- Most DPP-4 inhibitors require dose adjustments in advanced chronic kidney disease (CKD): 3, 1
- Sitagliptin: Reduce to 25 mg daily when eGFR <30 mL/min/1.73 m²
- Saxagliptin: Reduce to 2.5 mg daily when eGFR ≤45 mL/min/1.73 m²
- Alogliptin: Reduce to 6.25 mg daily when eGFR <30 mL/min/1.73 m²
- Only teneligliptin and linagliptin can be administered without dose adjustment across all stages of kidney disease 1
Efficacy in Renal Impairment
- Teneligliptin 20 mg once daily has demonstrated significant improvements in glycemic control in patients with diabetic kidney disease: 4
- Reduction in fasting plasma glucose
- Reduction in postprandial glucose
- Reduction in HbA1c
- Studies in hemodialysis patients have shown teneligliptin to be more potent than voglibose 0.2 mg three times daily or vildagliptin 50 mg once daily 5
Potential Renoprotective Effects
- Beyond glycemic control, teneligliptin has shown potential benefits for kidney function in patients with early diabetic kidney disease: 4
- Improvement in serum creatinine levels
- Increase in eGFR
- Reduction in proteinuria
- Teneligliptin may reduce biomarkers of kidney impairment such as P-selectin, platelet-derived microparticles, and plasminogen activator inhibitor-1 6
Safety Profile
- Teneligliptin is well-tolerated in patients with renal impairment with an adverse event profile similar to that observed in patients with normal renal function 7
- The risk of hypoglycemia remains low even in patients with severe renal impairment or those on dialysis 5
- No serious hypoglycemic events have been reported in clinical studies of teneligliptin in patients with renal impairment 7
Clinical Recommendations
- For patients with type 2 diabetes and any degree of renal impairment (mild to ESRD), administer teneligliptin at the standard dose of 20 mg once daily 1, 2
- No dose adjustment is required when initiating teneligliptin in patients with declining renal function 2
- Teneligliptin can be safely continued at the same dose if a patient progresses to more severe stages of kidney disease 6
- For patients on hemodialysis, maintain the standard 20 mg once daily dosing regimen 5
Monitoring Recommendations
- Regular monitoring of glycemic parameters (HbA1c, fasting and postprandial glucose) is recommended to assess efficacy 4
- Monitor renal function parameters (serum creatinine, eGFR, albuminuria) to track potential renoprotective effects 4
- Standard safety monitoring for DPP-4 inhibitors should be maintained, though no specific additional monitoring is required due to renal impairment 7