Antidiabetic Therapy in End‐Stage Renal Disease

There has been substantial growth in the variety of available antidiabetic agents during the last decade and a half. The role of these newer agents in patients with diabetes and end‐stage renal disease ( ESRD ) population, and their relative benefits and risks in this population compared to patients without ESRD are not yet clear. This stems from the altered state of glucose homeostasis in ESRD , which places patients at high risk for hypoglycemia and, in certain situations, hyperglycemia. In addition, there is a dearth of evidence to support a benefit of tight glycemic control on either micro‐ or macrovascular outcomes in ESRD patients; furthermore, the metrics by which glycemic control is conventionally measured are less valid in ESRD . In this review, we will discuss noninsulin and insulin‐based therapies as well as unique challenges, contraindications, advantages, and disadvantages to their use in ESRD . We will also review issues pertinent to both hemodialysis ( HD ) and peritoneal dialysis ( PD ) patients.