Published online Jun 25, 2015. doi: 10.4239/wjd.v6.i6.840
Peer-review started: August 23, 2014
First decision: September 28, 2014
Revised: March 16, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: June 25, 2015
Processing time: 302 Days and 5.8 Hours
Although several previous studies have been published on the effects of dipeptidase-4 (DPP-4) inhibitors in diabetic hemodialysis (HD) patients, the findings have yet to be reviewed comprehensively. Eyesight failure caused by diabetic retinopathy and aging-related dementia make multiple daily insulin injections difficult for HD patients. Therefore, we reviewed the effects of DPP-4 inhibitors with a focus on oral antidiabetic drugs as a new treatment strategy in HD patients with diabetes. The following 7 DPP-4 inhibitors are available worldwide: sitagliptin, vildagliptin, alogliptin, linagliptin, teneligliptin, anagliptin, and saxagliptin. All of these are administered once daily with dose adjustments in HD patients. Four types of oral antidiabetic drugs can be administered for combination oral therapy with DPP-4 inhibitors, including sulfonylureas, meglitinide, thiazolidinediones, and alpha-glucosidase inhibitor. Nine studies examined the antidiabetic effects in HD patients. Treatments decreased hemoglobin A1c and glycated albumin levels by 0.3% to 1.3% and 1.7% to 4.9%, respectively. The efficacy of DPP-4 inhibitor treatment is high among HD patients, and no patients exhibited significant severe adverse effects such as hypoglycemia and liver dysfunction. DPP-4 inhibitors are key drugs in new treatment strategies for HD patients with diabetes and with limited choices for diabetes treatment.
Core tip: Until now, the effectiveness of dipeptidase-4 (DPP-4) inhibitors on diabetic hemodialysis (HD) patients has not been reviewed. All 7 DPP-4 inhibitors are available for HD patients; administration is once daily with dose adjustments. The effectiveness of DPP-4 inhibitor treatment in HD patients is high, and adverse events do not increase as a result. DPP-4 inhibitors may prevent inflammation and atherosclerosis, which are principal prognostic factors for HD patients. In summary, DPP-4 inhibitors are key drugs in new treatment strategies for HD patients with diabetes and limited choices for its treatment.