The management of type II diabetes mellitus in patients with chronic kidney disease: a population-based study in Southern Italy

Clinical Drug Investigation

Gianluca Trifirò1, Fabrizio Parrino1, Valeria Pizzimenti1, Francesco Giorgianni1, Janet Sultana1, Marco Muscianisi1, Chiara Troncone2, Daniele UgoTari2, Vincenzo Arcoraci1, Domenico Santoro1, Giusi Russo1, Viviana Lacava1, Achille P. Caputi1

1Department of Clinical and Experimental Medicine, Pharmacology Section, University of Messina, Italy;

2 Caserta - Local Health Service, Caserta, Italy

Corresponding author:

Gianluca Trifirò, MD, PhD

Assistant Professor of Pharmacology, Department of Clinical and Experimental Medicine, PoliclinicoUniversitario G. Martino, Via Consolare Valeria, Messina 98125, Italy

e-mail:

tel. +39 0902213264

fax +39 0902213300

Online Resource1: Anti-diabetic drugs classified as “not contraindicated in CKD”, “contraindicated” or “requiring dose adjustment” based on clearance information. LegendAbbreviations-:CKD: chronic kidney disease

Not contraindicated in CKD / Contraindicated in CKD (creatinine clearance between 30-90 ml/min) / Contraindicated in CKD (creatinine clearance < 30 ml/min) / Contraindicated in CKD (without information on creatinine clearance) / Drugs requiring dose adjustment
Glipizide / Chlorpropamide / Glimepiride and pioglitazone combination therapy / Glibenclamide / Insulins
Glicazide / Rosiglitazone and metformin combination therapy / Acarbose / Gliquidone / Sitagliptin
Glimepiride / Pioglitazone andmetformin combination therapy / Exenatide / Phenformin and sulphonamide combination therapy / Vildagliptin
Rosiglitazone / Metformin and vildagliptin combination therapy / Liraglutide / Metformin and sulphonamides combination therapy / Saxagliptin
Pioglitazone / Metformin and sitagliptin combination therapy / - / - / -
Repaglinide / Metformin / - / - / -
Linagliptin / - / - / - / -

Online Resource 2: Time to discontinuation of specific anti-diabetic therapy during the first year following a new CKD diagnosis, stratified by drug class. Abbreviations- CKD: chronic kidney disease. Other anti-diabetic drugs were excluded from this analysis due to limited number of patients who were treated with these drugs (n=4).

Online Resource32: Number of CKD patients with diabetes (DKD) or without diabetes mellitus stratified by stage of kidney disease. Abbreviations- CKD: chronic kidney disease; DKD: diabetic kidney disease; DM: diabetes mellitus

CKD Stage / CKD patients without DM / DKD patients / Overall
N/A / 925 / 558 / 1,483
< 3 / 103 / 46 / 149
≥ 3 / 166 / 83 / 249

Online Resource43: Prevalence of anti-diabetic drug use per 100 inhabitants, stratified by time period and type of contraindication, based on recommendation from summary of product characteristics concerning use in patients with renal function impairment; this analysis was restricted to patients with advanced stages ofd CKD (≥ stage 3). No patients with staged CKD were prescribed anti-diabetic drugs contraindicated in creatinine clearance <30ml/min. The error bars represent the 95% confidence intervals.Statistical significance is denoted by non-overlapping error bars of the first and second column LegendAbbreviation-: ID: index date;CKD: chronic kidney disease. Statistical significance is denoted by non-overlapping error bars of the first and second column