Numerous drugs with different mechanisms of action and different pharmacologic profiles are being used with the aim of improving
glycemic control in patients with
type 2 diabetes. The therapeutic options for patients with
type 2 diabetes and
chronic kidney disease (CKD) are limited because the patients' reduced glomerular filtration rate results in the accumulation of certain drugs and/or their metabolites. Although recommended oral
antidiabetic agents for patients with CKD differ between countries, all of the currently available dipeptidyl peptidase-4 (DPP-4) inhibitors can be used in not only patients with CKD but also patients with
end-stage kidney disease on dialysis, and these inhibitors' use is increasing. Numerous clinical trials have shown that
DPP-4 inhibitors provide effective and consistent
glycemic control with a good tolerability profile and without severe
hypoglycemia or
weight gain. The
glucose-lowering effect of
DPP-4 inhibitors in diabetic patients with CKD is similar to the changes seen when
DPP-4 inhibitors are prescribed to patients without CKD. Therefore, kidney function is unaffected by treatment with
DPP-4 inhibitors. Moreover,
DPP-4 inhibitors reduce the levels of glycated
albumin, which is a better
indicator of
glycemic control than
glycated hemoglobin is, without
hypoglycemia in patients with
end-stage kidney disease undergoing dialysis. Furthermore, it has been suggested that
DPP-4 inhibitors might have a kidney-protective effect since they can potentially reduce the incidence of
albuminuria. Although these results suggest that
DPP-4 inhibitors can protect against
diabetic nephropathy, insufficient evidence is available to conclude that this class of agent directly prevents or decreases nephropathy in humans independently from improved
glucose control. Further long-term studies are needed to address whether
DPP-4 inhibitors reduce the development and progression of
diabetic nephropathy and improve cardiovascular outcomes in diabetic patients with CKD. Here, we describe the clinical efficacy and safety of
DPP-4 inhibitors for patients with CKD, including those receiving dialysis.