open access

Vol 71, No 1 (2020)
Guidelines
Published online: 2020-02-24
Submitted: 2019-11-25
Accepted: 2019-11-28
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Diagnosis and treatment of type 2 diabetes mellitus in patients with chronic kidney disease and eGFR < 60 mL/min — a position statement of the Polish Society of Nephrology Working Group on Metabolic and Endocrine Disorders in Kidney Diseases

Tomasz Stompór, Marcin Adamczak, Anna Masajtis-Zagajewska, Oktawia Mazanowska, Katarzyna Maziarska, Agnieszka Witkowska, Andrzej Więcek
DOI: 10.5603/EP.a2019.0064
·
Endokrynologia Polska 2020;71(1):3-14.

open access

Vol 71, No 1 (2020)
Guidelines
Published online: 2020-02-24
Submitted: 2019-11-25
Accepted: 2019-11-28

Abstract

Diabetes mellitus is one the most frequent co-morbid conditions in patients with chronic kidney disease (CKD), frequently leading to chronic kidney failure. Progression of CKD accelerates several metabolic disorders, predominantly those related to abnormalities of carbohydrate metabolism. Patients with CKD are usually characterised by an insulin resistance additionally aggravated by several co-morbid conditions (for example chronic low-grade inflammation). Treatment with anti-diabetic medications in patients with CKD remains a challenge because, along with the disease progression, the dosing of several drugs needs to be adjusted to the reduced kidney function (especially those that are excreted intact with urine or as active metabolites). Progression of CKD also increases the risk of hypoglycaemia in patients treated with anti-diabetic drugs, and other adverse drug reactions may occur more frequently. Usefulness of the new generation drugs has not yet been verified in patients with advanced kidney disease (although some of them act through kidney-related mechanisms). The current position statement of the Polish Society of Nephrology Working Group provides practical recommendations for the diagnosis and treatment of type 2 diabetes mellitus in patients with CKD and reduced kidney function.

Abstract

Diabetes mellitus is one the most frequent co-morbid conditions in patients with chronic kidney disease (CKD), frequently leading to chronic kidney failure. Progression of CKD accelerates several metabolic disorders, predominantly those related to abnormalities of carbohydrate metabolism. Patients with CKD are usually characterised by an insulin resistance additionally aggravated by several co-morbid conditions (for example chronic low-grade inflammation). Treatment with anti-diabetic medications in patients with CKD remains a challenge because, along with the disease progression, the dosing of several drugs needs to be adjusted to the reduced kidney function (especially those that are excreted intact with urine or as active metabolites). Progression of CKD also increases the risk of hypoglycaemia in patients treated with anti-diabetic drugs, and other adverse drug reactions may occur more frequently. Usefulness of the new generation drugs has not yet been verified in patients with advanced kidney disease (although some of them act through kidney-related mechanisms). The current position statement of the Polish Society of Nephrology Working Group provides practical recommendations for the diagnosis and treatment of type 2 diabetes mellitus in patients with CKD and reduced kidney function.

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Keywords

type 2 diabetes mellitus; chronic kidney disease; glucose metabolism; oral anti-diabetic drugs; incretin-based therapy; insulin; adverse events

About this article
Title

Diagnosis and treatment of type 2 diabetes mellitus in patients with chronic kidney disease and eGFR < 60 mL/min — a position statement of the Polish Society of Nephrology Working Group on Metabolic and Endocrine Disorders in Kidney Diseases

Journal

Endokrynologia Polska

Issue

Vol 71, No 1 (2020)

Pages

3-14

Published online

2020-02-24

DOI

10.5603/EP.a2019.0064

Bibliographic record

Endokrynologia Polska 2020;71(1):3-14.

Keywords

type 2 diabetes mellitus
chronic kidney disease
glucose metabolism
oral anti-diabetic drugs
incretin-based therapy
insulin
adverse events

Authors

Tomasz Stompór
Marcin Adamczak
Anna Masajtis-Zagajewska
Oktawia Mazanowska
Katarzyna Maziarska
Agnieszka Witkowska
Andrzej Więcek

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