From the Guidelines
Trajenta (linagliptin) does not significantly interfere with renal function, making it a preferred option for patients with kidney disease. Unlike other DPP-4 inhibitors, Trajenta is primarily eliminated through the enterohepatic system rather than the kidneys, with approximately 80% excreted via bile and only about 5% through renal elimination. This unique elimination pathway means that no dose adjustment is required for patients with any degree of renal impairment, including those with end-stage renal disease requiring dialysis, as supported by the 2019 standards of medical care for type 2 diabetes in China 1. Some key points to consider when prescribing Trajenta to patients with kidney disease include:
- Clinical studies have shown that Trajenta maintains consistent plasma concentrations regardless of kidney function status.
- Trajenta may offer renoprotective effects by reducing albuminuria and potentially slowing the progression of diabetic kidney disease through anti-inflammatory and antifibrotic mechanisms.
- The 2020 KDIGO clinical practice guideline for diabetes management in chronic kidney disease also supports the use of DPP-4 inhibitors, such as Trajenta, in patients with CKD, as they have been shown to have a neutral or mild effect on weight gain and do not increase the risk of hypoglycemia 1. Overall, Trajenta is a safe choice for type 2 diabetes patients with compromised kidney function who need glycemic control without adding stress to their renal system.
From the FDA Drug Label
Renal function as measured by mean eGFR and creatinine clearance did not change over 52 weeks' treatment compared to placebo.
Trajenta does not interfere with renal function. The study found that renal function, as measured by mean eGFR and creatinine clearance, did not change over 52 weeks of treatment compared to placebo 2.
From the Research
Trajenta and Renal Function
- Trajenta (linagliptin) is a dipeptidyl peptidase-4 (DPP-4) inhibitor used to treat type 2 diabetes mellitus 3, 4, 5.
- It is eliminated primarily via a nonrenal route, which enables its use without dosage adjustment in patients with any degree of renal impairment 3, 4, 5.
- Studies have shown that linagliptin improves glycaemic control in patients with renal impairment, including severe impairment, without affecting renal function 3, 4, 5.
- A prospective randomized controlled study found that linagliptin improved renal progression in type 2 diabetes mellitus patients with chronic kidney disease, with a significant increase in eGFR 6.
- Another study suggested that GLP-1 receptor agonists, a different class of diabetes medications, may also help prevent renal complications of type 2 diabetes, but this is not directly related to Trajenta 7.
Key Findings
- Linagliptin does not require dose adjustment in patients with renal impairment 3, 4, 5.
- Linagliptin improves glycaemic control in patients with renal impairment without affecting renal function 3, 4, 5.
- Linagliptin may improve renal progression in type 2 diabetes mellitus patients with chronic kidney disease 6.