Single sample, urine albumin/creatinine ratio (mg/mmol)1 | Timed overnight collection, urine albumin (µg/min) | 24-hour collection, urine albumin (mg/24 hours) | |
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1 Reference values vary between laboratories. The ranges given in the table allow for inaccuracy related to the sample or the assay methods. | |||
Normal | <3 | <20 | <30 |
Moderately increased albuminuria (previously microalbuminuria') | 3-30 | 20-200 | 30-300 |
Severely increased albuminuria (previously macroalbuminuria' or proteinuria') | >30 | >200 | >300 |
Estimated GFR | eGFR 45-59 | eGFR 30-44 | eGFR 15-29 | eGFR < 15 |
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1 No dose adjustment is required due to renal failure but the drug is not recommended for patients with renal failure because of the likelihood of increased oedema. 2 No dose adjustment if eGFR > 50 ml/min; not recommended if eGFR < 50 ml/min. Source: Ilanne-Parikka P, Niskanen L, Rönnemaa T, Saha M-T (Eds.). Diabetes. Kustannus Oy Duodecim (Duodecim Publishing Company Ltd) 2019. Summaries of product characteristics August 2022: Terveysportti health portal / Duodecim lääketietokanta [Duodecim pharmaceutical database].(in Finnish) | ||||
Metformin | Dose reduction Do not exceed 2 g | Dose reduction Halve the dose. | Contraindicated | Contraindicated |
Glimepiride | Not recommended | Not recommended | Contraindicated | Contraindicated |
Repaglinide | No dose adjustment | No dose adjustment | Dose reduction | Dose reduction |
Pioglitazone1 | Not recommended due to adverse effects (as such, the dose does not need to be adjusted in renal failure) | Not recommended, see column 2. | Not recommended, see column 2. | Not recommended. There is no information regarding dialytic therapy. |
Alogliptin | No dose adjustment | Halving of the dose starting from 50 ml/min (12.5 mg/day) | Dose reduction to a quarter of the recommendation (6.25 mg/day) | Dose reduction to a quarter of the recommendation (6.25 mg/day). |
Linagliptin | No dose adjustment | No dose adjustment | No dose adjustment | No dose adjustment |
Saxagliptin | Dose reduction | Dose reduction | Dose reduction | Not recommended |
Sitagliptin | No dose adjustment | Dose reduction | Dose reduction | Dose reduction |
Vildagliptin | Dose reduction | Dose reduction | Dose reduction | Dose reduction |
Dulaglutide | No dose adjustment | No dose adjustment | No dose adjustment | Not recommended |
Short-acting exenatide | No dose adjustment | Careful dose increase | Not recommended | Not recommended |
Long-acting Long-acting exenatide | No dose adjustment2 | Not recommended | Not recommended | Not recommended |
Lixisenatide | No dose adjustment | No dose adjustment | Not recommended | Not recommended |
Liraglutide | No dose adjustment | No dose adjustment | No dose adjustment | Not recommended |
Semaglutide | No dose adjustment | No dose adjustment | No dose adjustment | Not recommended |
Dapagliflozin | No dose adjustment | No dose adjustment | Not recommended due to little experience when eGFR < 25 ml/min. | Not recommended |
Empagliflozin | 10 mg/day | 10 mg/day | Not recommended. In heart failure, when eGFR > 20 ml/min, dose 10 mg/day. | Not recommended |
Ertugliflozin | Initial dose 5 mg/day, can be increased gradually to 15 mg/day. | The use and initiation of treatment are not recommended. | Must be stopped | Must be stopped |
Insulin | No dose adjustment | Individual dose adjustment | Individual dose adjustment | Individual dose adjustment |