The management of diabetes mellitus in patients with
chronic kidney disease: a population-based study in
Southern Italy
Clinical Drug Investigation
Gianluca Trifirò1, Fabrizio Parrino1, Valeria Pizzimenti1, Francesco Giorgianni1, Janet
Sultana1, Marco Muscianisi1, Chiara Troncone2, Daniele UgoTari2, Vincenzo Arcoraci1,
Domenico Santoro1, Giusi Russo1, Viviana Lacava 1, Achille P. Caputi1
1Department
of Clinical and Experimental Medicine, Pharmacology Section, University of
Messina, Italy;
2 Caserta
- Local Health Service, Caserta, Italy
Corresponding author:
Gianluca Trifirò, MD, PhD
Assistant Professor of Pharmacology, Department of Clinical and Experimental Medicine,
Policlinico Universitario G. Martino, Via Consolare Valeria, Messina 98125, Italy
e-mail: [email protected]
tel. +39 0902213264
fax +39 0902213300
Online Resource 1: Anti-diabetic drugs classified as “not contraindicated in CKD”, “contraindicated”
or “requiring dose adjustment” based on clearance information. Abbreviations- CKD: chronic kidney
disease
Not
contraindicated
in CKD
Contraindicated in
CKD (creatinine
clearance between
30-90 ml/min)
Contraindicated
in CKD
(creatinine
clearance < 30
ml/min)
Contraindicated in
CKD (without
information on
creatinine
clearance)
Drugs
requiring
dose
adjustment
Glipizide
Chlorpropamide
Glimepiride and
pioglitazone
combination
therapy
Glibenclamide
Insulins
Glicazide
Rosiglitazone and
metformin
combination therapy
Acarbose
Gliquidone
Sitagliptin
Glimepiride
Pioglitazone and
metformin
combination therapy
Exenatide
Phenformin and
sulphonamide
combination
therapy
Vildagliptin
Rosiglitazone
Metformin and
vildagliptin
combination therapy
Liraglutide
Metformin and
sulphonamides
combination
therapy
Saxagliptin
Pioglitazone
Metformin and
sitagliptin
combination therapy
-
-
-
-
-
-
-
-
Repaglinide
Linagliptin
Metformin
-
Online Resource 2: Time to discontinuation of specific anti-diabetic therapy during the first year
following a new CKD diagnosis, stratified by drug class. Abbreviations- CKD: chronic kidney disease.
Other anti-diabetic drugs were excluded from this analysis due to limited number of patients who were
Survival
treated with these drugs (n=4).
Days since new CKD diagnosis
Online Resource 3: Number of CKD patients with diabetes (DKD) or without diabetes
mellitus stratified by stage of kidney disease. Abbreviations- CKD: chronic kidney disease;
DKD: diabetic kidney disease; DM: diabetes mellitus
CKD Stage
CKD patients without
DM
DKD patients
Overall
N/A
925
558
1,483
<3
103
46
149
≥3
166
83
249
Online Resource 4: Prevalence of anti-diabetic drug use per 100 inhabitants, stratified by time period
and type of contraindication; this analysis was restricted to patients with advanced stages of CKD (≥
stage 3). No patients were prescribed anti-diabetic drugs contraindicated in creatinine clearance
<30ml/min. The error bars represent the 95% confidence intervals. Statistical significance is denoted
by non-overlapping error bars of the first and second column Abbreviation- ID: index date; CKD:
Prevalence of anti-diabetic drug use per 100 inhabitants (%)
chronic kidney disease.
70
One year prior to ID
One year after ID
60
50
40
30
20
10
0
Contraindicated in CKD Contraindicated in CKD Drugs requiring dose
(without information on (creatinine clearance
adjustment
creatinine clearance) between 30-90 ml/min)
Not contraindicated in
CKD
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The management of type II diabetes mellitus in patients with chronic