Application of sulfonylureas in diabetic patients with chronic kidney disease - AJKD2022 Core Course Recommendations

The number of people with diabetes (DM) worldwide is increasing every year, and about 34 million children and adults in the United States currently have diabetes, and diabetes is the most common cause of
kidney failure.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in people with diabetes, and CKD further increases the overall risk of CVD in
patients.

CKD alters the relationship between blood glucose levels and long-term control indicators, such as glycosylated hemoglobin
.

In view of the hypoglycemic risk of insulin and sulfonylureas, the core course recommendation also gives corresponding medication recommendations
.

Blood glucose control has been shown to slow the development of
cardiovascular disease and chronic kidney disease.

Guiding individual HbA1c control factors in goal decision making

Patients with CKD are at increased risk of hypoglycemia after insulin use, especially in the elderly, potentially frail, and osteodystrophy, because falls caused by hypoglycemia can easily lead to severe fractures, so when insulin is applied, careful monitoring of blood glucose is required to safely adjust the insulin dose, reduce the risk of hypoglycemia, and achieve blood glucose control goals
.

The representative drugs that are easy to cause hypoglycemia in oral hypoglycemic drugs are sulfonylureas
.

In specific applications, it is recommended that when eGFR < 60 mL/min/1.

Medication dose adjustment for diabetes mellitus in patients with CKD

For patients who already need hemodialysis, it is well known that the blood glucose response during hemodialysis is very variable and unpredictable, so it may be necessary to adjust the dose
frequently.

Overall, this section of the AJKD Nephropathy Core curriculum discusses blood glucose control goals, the use of diabetes medications, and management strategies
for patients with CKD type 1 and type 2 diabetes.

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