The best diabetes medication for kidney disease can vary depending on the severity of your kidney damage. You may need a medication that doesn’t require dose adjustment based on your kidney function.

Diabetes without proper treatment or management may lead to further complications, one being kidney damage. Too much sugar in your blood will slowly damage your kidneys as they try to filter the excess sugar.

Today, lots of medications for people with both diabetes and chronic kidney disease (CKD) are available.

People with CKD should take their medication at a safe and effective dose so the body can properly filter the drug. A healthcare professional can determine the proper dose.

Not all medications will need dose adjustments based on how well your kidneys are working. Antidiabetes medications that don’t need dose adjustment for kidney function include:

Although GLP-1s, such as dulaglutide, liraglutide, and semaglutide, may protect your kidneys, side effects of these medications may include gastrointestinal symptoms that lead to dehydration and acute kidney injuries.

Your doctor may also recommend starting insulin at a lower dose to avoid low blood sugar (hypoglycemia) due to the decreased glomerular filtration rate (GFR) in CKD.

Diabetes medications to avoid when there’s severe kidney damage include:

For people with CKD, your kidneys don’t remove excess fluids as efficiently, so it’s important to recognize medications that have the potential for fluid retention. Fluid retention can be harmful because it may cause:

Diabetes medications to avoid due to the potential for fluid retention are:

Diabetes is a risk factor that increases the chance of cardiovascular (heart) diseases, including:

Diabetes medications shown to benefit people with heart disease and diabetes include:

Diabetes medications shown to benefit people with heart failure and diabetes are:

You may use glimepiride but should consider starting at a low dose (1 milligram daily) and increasing the dose cautiously if you have mild to severe kidney disease. Speak with your doctor about their recommendations.

If GFR is below 30, you should avoid using glimepiride.

People with acute kidney injury should stop or avoid taking metformin. If you’re already taking it, speak with your doctor before stopping.

If your GFR is between 46 and 60, your dose should be reduced, and if it falls below 45, metformin should be stopped.

Managing your diet and weight, getting enough physical activity, and avoiding smoking if you smoke can have a positive impact on managing diabetes and protecting the kidneys.

Speak with your doctor about a smoking cessation program if you smoke and are looking to quit.

Try to also lower your intake of carbohydrates and alcohol (if you drink). You might also consider avoiding alcohol altogether.

The number one cause of CKD is diabetes. Managing your diabetes is important so it doesn’t lead to severe kidney damage.

Work with a healthcare professional to determine the right medication or medications to manage both diabetes and kidney disease.

Try to make appropriate lifestyle changes, which are effective ways of managing diabetes and kidney disease.

Dr. Monica Kean

Dr. Monica Kean is a clinical pharmacist with experience in hospital pharmacy and long-term care. She has experience helping people in internal medicine, emergency medicine, and critical and hospice care. Dr. Kean currently practices as a clinical pharmacist at Texas Arlington Memorial Hospital.