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Gliclazide Hypoglycaemia Advanced CKD Stop — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseGliclazide Hypoglycaemia Advanced CKD StopESENeph

A 48-year-old man with CKD G4 (eGFR 22 mL/min/1.73m2) and type 2 diabetes has an HbA1c of 64 mmol/mol. He is on insulin glargine, metformin (recently stopped due to low eGFR), and gliclazide 80 mg BD. He has a recurrent hypoglycaemic episode with blood glucose 2.8 mmol/L. What is the MOST important medication adjustment?

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Correct answer: E — Stop gliclazide and titrate insulin

Gliclazide and other sulphonylureas carry increased hypoglycaemia risk in advanced CKD due to accumulation of active metabolites and prolonged duration of action. The reduced renal clearance extends their glucose-lowering effect unpredictably. In CKD G4-5, gliclazide should be used with great caution or stopped, particularly with recurrent hypoglycaemia. Insulin dose should be titrated carefully (insulin requirements often DECREASE in advanced CKD due to reduced renal insulin clearance). KDIGO 2024 recommends individualised HbA1c targets in advanced CKD (typically 7-8%/53-64 mmol/mol) to avoid hypoglycaemia.

Reference: KDIGO 2024 – CKD Guideline; BNF 2024 – Gliclazide in Renal Impairment