Comparing The Safety and Efficacy of Sitagliptin Vs Dapagliflozin and The Risk of Hyperkalaemia Among People with Type 2 Diabetes Mellitus and Kidney Disease

Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD), and the coexistence of both conditions complicates glycemic management. Novel oral antidiabetic agents, including dipeptidyl peptidase-4 (DPP-4) inhibitors such as sitagliptin and sodium-glucose cotransporter-2 (SGLT2) inhibitors such as dapagliflozin, have expanded therapeutic options. However, the risk of electrolyte disturbances, particularly hyperkalemia, remains an important consideration. To compare the safety and efficacy of sitagliptin and dapagliflozin in patients with T2DM and CKD, with emphasis on the risk of hyperkalemia.A narrative review of available clinical trial and observational data was conducted, focusing on glycemic efficacy, renal and cardiovascular outcomes, and electrolyte effects of sitagliptin and dapagliflozin in patients with varying degrees of CKD. Sitagliptin improves glycemic control by enhancing glucose-dependent insulin secretion and suppressing glucagon, with minimal effects on serum potassium. It is well tolerated in moderateto-severe CKD when dose adjusted. Dapagliflozin exerts renoprotective and cardioprotective benefits by lowering intraglomerular pressure, promoting natriuresis, and improving metabolic parameters. Clinical evidence indicates dapagliflozin slows CKD progression and reduces hospitalization for heart failure, including in advanced CKD. However, by modulating the reninangiotensin-aldosterone system, it may influence potassium balance, necessitating electrolyte monitoring, particularly in patients receiving concomitant renin-angiotensin inhibitors.Dapagliflozin appears to provide superior renal and cardiovascular outcomes compared to sitagliptin in T2DM with CKD, but requires vigilance for potential hyperkalemia. Sitagliptin remains a safe alternative for glycemic control with stable electrolyte effects. Individualized treatment should consider renal function, comorbidities, and concomitant therapies. Large-scale randomized controlled trials are needed to better define the relative hyperkalemia risk and guide optimal therapeutic strategies in this high-risk population.