Diabetes-prescribing in renal impairment

Metformin -reduce dose if GFR < 45 consider starting at half of the max dose follow renal function closely e.g every 3-6 months rare risk of lactic acidosis- inform patients

Gliclazide- Gliclazide and Glipizide are metabolised in the liver and are preferred SUs for patients with type 2 diabetes and CKD .BNF states that use sulfonylureas with caution in mild to moderate renal impairment - hazard of hypoglycemia Consider using a reduced dose if GFR < 45 If GFR < 45 and patient on Insulin - consider avoiding SUs unless clear evidence of absence of hypoglycemia

Glibenclamide -use a reduced dose and monitor.

Glimeperide - use with caution in mild to moderate renal impairment. Glipizide -use sub maximal dose in mild -moderate renal impairment,

Tolbutamide -Use a lower dose and careful monitoring of Bl glucose- risk of hypoglycemia

Neteglinide -metabolised in liver licensed for use in all stages of CKD.Slightly increased risk of hypoglycemia when GFR < 60

Repaglinide-metabolised in liver and excreted unchanged via the kidneys- safe to use in all stages of CKD.

Pioglitazone -Consider use in all stages of CKD ( avoid if heart failure or macular oedema , known bladder cancer )

Allogliptin -reduce dose in...