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A 71-year old patient was admitted to the hospital. The patient had a history of type-2 diabetes, peripheral vascular insufficiency, and severe kind of chronic kidney disease (i.e. Stage 5) that was occurred due to diabetic nephropathy. In the past 10 months, the patient underwent the process of hemodialysis 3 times per week for 3 hours and 30 minutes every time. The patient was increasingly showing forgetfulness in the past year. In the past 2 weeks, the patient also started showing confusion and having visual hallucinations, and the symptoms of the patient become more persistent in the last 2 days (Mansfield & Qian, 2009).
The patient was taking atenolol, stable doses of aspirin, calcium acetate, atorvastatin, gabapentin, insulin, and vancomycin. Four times daily administration of 300 mg gabapentin was helping the patient in controlling the diabetic neuropathic pain for several years (Mansfield & Qian, 2009). Linagliptin, a drug from the class of dipeptidyl peptidase-4 inhibitor, can also be used for the patient. In a study, researchers reported that in patients having type 2 diabetes and severe kind of kidney disorder, linagliptin can result in clinically meaningful improvements in glycemic control. It has very low risk of causing severe hypoglycemia or drug-related renal failure (McGill et al., 2013).
In the patient having renal disorder, it is important to note that medication toxicity can occur even when it is used in general reference range. Therefore, drug dosing has to be properly and regularly monitored in the patient of renal disorder; otherwise, some damaging and potentially life-threatening toxicities can develop in the patient (Mansfield & Qian, 2009). Moreover, the patient has to be checked for the use of electrolytes, malnutrition, and acceptable fluid volume status (Buttaro, 2013).
References
Buttaro, T. M. (2013). Primary Care: A Collaborative Practice: Elsevier/Mosby.
Mansfield, A. S., & Qian, Q. (2009). 71-year-old man with chronic kidney failure and sudden change of mental status. Paper presented at the Mayo Clinic Proceedings.
McGill, J. B., Sloan, L., Newman, J., Patel, S., Sauce, C., von Eynatten, M., & Woerle, H.-J. (2013). Long-Term Efficacy and Safety of Linagliptin in Patients With Type 2 Diabetes and Severe Renal Impairment A 1-year, randomized, double-blind, placebo-controlled study. Diabetes Care, 36(2), 237-244.
