Do you have diabetes and chronic kidney disease (CKD)? Patients with these conditions are often on multiple medications, and may be worried about how their diabetes medications are affecting their kidneys. Here, pharmacist Monica Kean addresses common questions and concerns regarding diabetes drugs, including which ones are considered best for CKD patients and which ones may be dangerous.* 

Which diabetes drugs are safe for CKD patients?

When diabetes is not managed or controlled, it will affect other parts of the body, including the kidneys. Certain diabetes medications are ideal for CKD patients, as they can help improve blood sugars and reduce CKD progression. Some of these medications also have proven benefits for heart diseases. According to Kean, these medications include:

• Canagliflozin 
• Empagliflozin 
• Dapagliflozin 
• Liraglutide 
• Semaglutide 
• Dulaglutide

Some diabetes medications are generally safe for CKD patients if the dosage is properly adjusted. Antidiabetic drugs that don’t require readjustment include:

• Dulaglutide 
• Liraglutide 
• Semaglutide 
• Linagliptin 
• Insulin 

Which diabetes medications should be avoided with CKD?

As CKD progresses and becomes severe, certain medications become unsafe. Kean advises that diabetes medications that can increase blood pressure, cause fluid retention, or lead to other kidney-related complications should be avoided in the later stages of CKD. These include:

• Metformin 
• Ertugliflozin 
• Dapagliflozin 
• Canagliflozin 
• Empagliflozin 
• Exenatide 
• Lixisenatide 
• Pioglitazone 
• Rosiglitazone 
• Glyburide 

Is glimepiride safe for kidneys?

According to Kean, glimepiride should be taken with care, and avoided in patients with kidney failure. “Patients with mild to severe kidney disease may use glimepiride,” she says, “but should consider starting at a low dose (1 milligram daily) and increasing the dose cautiously.”

What advice would you give people who are managing both diabetes and kidney disease?

One of the most common reasons for CKD developing and progressing is diabetes. Working closely with your healthcare provider will help you to determine the right medication(s) to manage both diabetes and CKD. Make sure to ask questions so that you understand:

• What medication(s) are being prescribed, 
• What result they’re supposed to achieve, 
• What possible side effects you could experience, and 
• Their potential interactions with other medications, foods, or supplements you’re taking. 

Your doctor also can provide guidance regarding lifestyle changes that may help manage your conditions. 

*Kean, M. P. (2022, June 8). Ask the Expert: Which Diabetes Drug Is Best for People with Kidney Disease? Healthline. https://www.healthline.com/health/type-2-diabetes/diabetes-drug-kidney-disease#managing-diabetes-and-kidney-disease

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