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The Outcome of DPP-4 Inhibitors in Type 2 Patients on Hemodialysis

Decreased chance of hypoglycemic event and greater safety profile shown in use of this therapy…

Diabetes is the main reason for renal failure in today’s population. Currently, the main treatment option for a hemodialysis diabetic patient is insulin therapy. Insulin therapy is a difficult regimen for many patients due to the serious side effects of hypoglycemia and weight gain. Dipeptidyl peptidase-4 (DPP-4) inhibitors are used frequently because of a decreased chance of hypoglycemic event and greater safety profile. They also have been shown to protect patients from atherosclerosis and decrease the chance of cardiovascular events. Based on the clinical trials, DPP-4 inhibitors may maximize the quality of life for type 2 patients who are on hemodialysis. Although this information is well known, currently there is no study that evaluates the new medications on the market in type 2 patients who are on hemodialysis.

This study evaluated trials conducted from 1966 to 2014. The keywords used in the search were “DPP-4 inhibitor,” “hemodialysis,” “end stage renal disease,” “sitagliptin,” “vildagliptin,” “alogliptin,” “linagliptin,” “teneligliptin,” “anagliptin,” “saxagliptin,” “glucagon-like peptide-1 (GLP-1),” “insulin,” “glucagon,” and “insulin resistance.” There were nine trials that evaluated the effects of antidiabetic medication in type 2 diabetics who are on hemodialysis.

The results showed that the DPP-4 therapy reduced HbA1c levels and glycated albumin levels by 0.3% to 1.3% and 1.7% to 4.9%, respectively. In this study, no patients experienced any major adverse events (hypoglycemia and liver dysfunction) due to the diabetes medication regimen. DPP-4 is commonly associated with rash, hives, abdominal fullness, pancreatitis, constipation, headache, giddiness, nasopharyngitis, headache, and upper respiratory tract infection. The incidence of these events were very low in the trial.

To conclude, DPP-4 inhibitors have a great safety profile amongst hemodialysis patients with type 2 diabetes. Recently, there have been a couple of DPP-4 inhibitors that arrived on the market. Because of the expansion of this medication class, there is an expansion in the number of treatment options for hemodialysis patients with type 2 diabetes.

Practice Pearls:

  • Based on this research, DPP-4 inhibitors do not cause more adverse events in hemodialysis patients.
  • DPP-4 inhibitors can reduce HbA1c levels in patients with type 2 diabetes.
  • This research shows that DPP-4 inhibitors can be a new treatment for hemodialysis with diabetes.

Nakamura Y, Hasegawa H, Tsuji M, et al. “Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors.” World J Diabetes. 2015;6(6):840-9.