Vildagliptin in patients with chronic kidney disease and in the elderly

Diabetic kidney disease is the leading cause of end-stage renal disease and the main cause of renal replacement therapy. Treatment of diabetic patients is challenging especially among older patients and in patients with chronic kidney disease (especially those on dialysis). Many commonly used drugs in patients with diabetes type 2 may generate a risk of medication-induced hypoglycemia and require dose reduction in various stages of chronic kidney disease. Combination therapy instead of monotherapy becomes widely accepted and dipeptidyl-peptidase-4 inhibitors, as a relatively new class of non-insulin glucose-lowering agents play an increasing role. Among which vildagliptin has a beneficial effect on glycaemic control. The decrease in blood concentration of glycated hemoglobin (HbA1c), fasting plasma glucose concentration, and improvement of lipid profiles without increasing weight and the risk of hypoglycaemia are very encouraging. Due to its pleiotropic effects vildagliptine reduces also blood pressure, improves lipid metabolism and exerts a nephroprotective effect. It can be also successfully used in the elderly subjects, in patients with chronic kidney disease as well as in dialysis patients.