Metformin in CKD — ESENeph MCQ
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Correct answer: C — Stop metformin and select an alternative glucose-lowering strategy
Current UK guidance does not permit metformin when eGFR is below 30 mL/min/1.73 m² because accumulation increases lactic-acidosis risk during intercurrent illness or AKI. The original keyed advice to continue cautiously until eGFR fell below 15 directly contradicted the adjacent item and current NICE guidance. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.
Reference: NICE NG28: Type 2 diabetes in adults—initial medicines. https://www.nice.org.uk/guidance/ng28/chapter/initial-medicines