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The management of hyperglycemia in the patient with kidney disease (KD) is complex. The strict control of glycemia and risk factors, may avoid the onset and progression of KD, so it is important to achieve strict glycemic targets and select drugs that reduce albuminuria and drop of glomerular filtration. In addition, we should consider that in patients with KD some drugs have proved a direct effect on the kidney, regardless of glycemia reduction. Other factors of the KD itself should be taken into account at the moment of treatment, such as major hydrosaline retention, cardiovascular risk, hypoglycemia risk, major half-life of drugs and fracture risk, among others.