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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 25, 2015; 6(6): 840-849
Published online Jun 25, 2015. doi: 10.4239/wjd.v6.i6.840
Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors
Yuya Nakamura, Hitomi Hasegawa, Mayumi Tsuji, Yuko Udaka, Masatomo Mihara, Tatsuo Shimizu, Michiyasu Inoue, Yoshikazu Goto, Hiromichi Gotoh, Masahiro Inagaki, Katsuji Oguchi
Yuya Nakamura, Masatomo Mihara, Tatsuo Shimizu, Michiyasu Inoue, Yoshikazu Goto, Hiromichi Gotoh, Saiyu Soka Hospital, Kitaya, Soka-city Saitama-ken 340-0046, Japan
Hitomi Hasegawa, Mayumi Tsuji, Yuko Udaka, Katsuji Oguchi, Department of Pharmacology, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
Masahiro Inagaki, Department of Chemistry, College of Arts and Sciences, Showa University, Kamiyoshida, Fujiyoshida-city, Yamanashi-ken 403-0005, Japan
Author contributions: Nakamura Y devised the study concept and design; Nakamura Y searched the literature; Nakamura Y, Shimizu T, Goto Y and Gotoh H analyzed the literature; Nakamura Y, Hasegawa H, Udaka Y and Mihara M interpreted the literature; Nakamura Y drafted the article; Nakamura Y, Tsuji M and Inagaki M revised the article for important intellectual content; Oguchi K gave final approval for the article.
Conflict-of-interest: There are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yuya Nakamura, MD, Saiyu Soka Hospital, 1-21-37, Kitaya, Soka-city Saitama-ken 340-0046, Japan. y.nakamura@med.showa-u.ac.jp
Telephone: +81-4-89446111 Fax: +81-4-89448080
Received: August 22, 2014
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
Abstract

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.

Keywords: Dipeptidase-4 inhibitors, Hemodialysis, Diabetes mellitus, Blood glucose-related factors, Anti-inflammatory effects

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.