Does sitagliptin (Januvia) need to be held in patients with Acute Kidney Injury (AKI)?

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Last updated: April 13, 2025 • View editorial policy

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From the Guidelines

Sitagliptin should be temporarily discontinued in patients with acute kidney injury (AKI) due to the potential for decreased clearance and accumulation of the drug, which can increase the risk of side effects such as hypoglycemia. According to the 2025 standards of care in diabetes, dose adjustment is required for sitagliptin based on kidney function 1. The medication is primarily eliminated by the kidneys, with approximately 80% excreted unchanged in the urine. During AKI, reduced kidney function can lead to decreased clearance and accumulation of the drug.

Key Considerations

  • For patients with established chronic kidney disease, dose adjustments are recommended, with 50 mg daily for moderate renal impairment with eGFR 30-45 mL/min, and 25 mg daily for severe renal impairment with eGFR <30 mL/min 1.
  • During the period when sitagliptin is held, alternative glycemic control measures should be implemented, which may include insulin therapy for inpatients or temporary adjustment of other diabetes medications that have less dependence on renal clearance.
  • Once kidney function stabilizes or improves, sitagliptin can typically be restarted, possibly at a lower dose depending on the patient's new baseline kidney function.

Clinical Implications

  • It is essential to monitor kidney function and adjust the dose of sitagliptin accordingly to minimize the risk of side effects and ensure optimal glycemic control 1.
  • Healthcare providers should be aware of the potential for decreased clearance and accumulation of sitagliptin in patients with AKI and take appropriate measures to prevent adverse effects.

From the Research

Sitagliptin and Acute Kidney Injury (AKI)

  • Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor used to treat type 2 diabetes mellitus.
  • The management of AKI involves addressing the underlying cause, optimizing fluid balance, and discontinuing or dose-adjusting nephrotoxic drugs 2.
  • There is no direct evidence in the provided studies that specifically addresses whether sitagliptin needs to be held for AKI.
  • However, the general principle of managing AKI includes discontinuing or dose-adjusting drugs that are nephrotoxic or have renal elimination 2, 3.
  • It is essential to note that sitagliptin is primarily excreted unchanged in the urine, and its dose needs to be adjusted in patients with renal impairment.
  • In patients with AKI, the renal clearance of drugs, including sitagliptin, may be reduced, potentially leading to increased drug concentrations and adverse effects.
  • Therefore, it may be necessary to adjust the dose of sitagliptin or hold it temporarily in patients with AKI, depending on the severity of the renal impairment and the patient's clinical condition.

Clinical Considerations

  • The classification of AKI includes changes in serum creatinine concentrations and urine output 2, 4, 3.
  • The treatment of AKI is aimed at addressing the underlying cause, limiting damage, and preventing progression 2, 4, 3.
  • In patients with AKI, it is crucial to monitor renal function, electrolyte disturbances, and drug concentrations to adjust treatment accordingly.
  • The management of AKI requires a multidisciplinary approach, including nephrology consultation, to optimize patient outcomes 3.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Acute Kidney Injury: Diagnosis and Management.

American family physician, 2019

4
Research

Acute Kidney Injury.

Primary care, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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