Therapeutic Considerations for Antihyperglycemic Agents in Diabetic Kidney Disease

J Am Soc Nephrol. 2017 Aug;28(8):2263-2274. doi: 10.1681/ASN.2016121372. Epub 2017 May 2.


Diabetic kidney disease is among the most frequent complications of diabetes, with approximately 50% of patients with ESRD attributed to diabetes in developed countries. Although intensive glycemic management has been shown to delay the onset and progression of increased urinary albumin excretion and reduced GFR in patients with diabetes, conservative dose selection and adjustment of antihyperglycemic medications are necessary to balance glycemic control with safety. A growing body of literature is providing valuable insight into the cardiovascular and renal safety and efficacy of newer antihyperglycemic medications in the dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, and sodium-glucose cotransporter 2 inhibitor classes of medications. Ongoing studies will continue to inform future use of these agents in patients with diabetic kidney disease.

Keywords: diabetes; diabetes mellitus; renal protection.

Publication types

  • Review

MeSH terms

  • Diabetic Nephropathies / drug therapy*
  • Diabetic Nephropathies / etiology
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Practice Guidelines as Topic
  • Renal Insufficiency, Chronic / complications


  • Hypoglycemic Agents