[Use of oral glucose-lowering agents in patients with renal impairment].

People with chronic kidney disease (CKD) of stages 3-4 (creatinine clearance <50 ml/min) represent 25-30% of type 2 diabetic patients, but the problem is often underrecognized or neglected in clinical practice. However, most of oral antidiabetic agents have limitations in case of renal impairment, either because they require a dose adjustment, or because they are contra-indicated for safety reasons. It is the case for metformin (risk of lactic acidosis) and for most sulfonylureas (risk of hypoglycaemia). New antidiabetic agents are better tolerated in case of CKD. However, the daily dose of dipeptidyl peptidase-4 inhibitors should be adjusted (except for linagliptin). Concerning new inhibitors of renal SGLT2 cotransporters, they have a reduced efficacy and their safety remains to be demonstrated in presence of CKD.