Gliclazide Hypoglycaemia ESKD — ESENeph MCQ
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Correct answer: B — De-intensify therapy and use glucose profiles
Recurrent hypoglycaemia requires de-intensification, and a sulfonylurea should be stopped or reduced under specialist review. Dialysis reduces renal gluconeogenesis and insulin clearance, while anaemia, ESA exposure and shortened red-cell survival make HbA1c less reliable. The original explanation incorrectly implied that active gliclazide metabolites simply accumulate; the clinically important conclusion is overtreatment, not that inaccurate mechanism. 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: KDIGO 2024 Clinical Practice Guideline for CKD. https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf; NICE NG28: Type 2 diabetes in adults—initial medicines. https://www.nice.org.uk/guidance/ng28/chapter/initial-medicines