Mortality risk for people with chronic kidney disease (CKD) and diabetes is greater than the risk for people with CKD alone. Diabetes management for patients with CKD involves considerations including increased risk of hypoglycaemia and medication dose adjustments.
The aims of this prospective observational study were to observe prescribing trends of hypoglycaemic agents used in inpatients with diabetes and CKD and their demographics, renal function and anthropometric baseline.
Records of all patients either admitted to CRGH under the Renal team OR required a Renal consultation from April-July 2024 were reviewed and patients who were diagnosed with diabetes PRIOR to admission and had a baseline eGFR of <60mL/min/1.73m2 were included. Data related to diabetes and renal function, and medications were collected.
45 patients were included for analysis. The mean age was 73±12 years, mean eGFR was 17.5±13.5 mL/min, and mean HbA1c was 6.9±1.5%. 44% of patients were using insulin on admission with mixed insulin being the most prescribed insulin (24%). (13/16) 81.3% of patients taking metformin on admission had this ceased due to renal impairment. All patients taking SGLT-2 inhibitors (5/45) 11% on admission had them withheld peri-operatively or due to renal impairment. Baseline Egfr in this cohort was 20 ml/min/1.73m^2+/-SD. The most commonly prescribed oral hypoglycemic agent was DPP4 inhibitor, taken by (25/45) 55% of patients, of which 88% were taking linagliptin. (1/4) 25% of patients taking sulfonylureas on admission had this ceased due to episodes of hypoglycaemia. All 3 patients using GLP-1 agonists on admission had it ceased secondary to worsening renal function.
In this cohort, mixed insulin regimens and DPP-IV inhibitors were the most commonly prescribed diabetic medications. Patients on oral hypoglycaemic agents or insulin had their respective medications appropriately ceased or dose reduced. There was a lower-than-expected rate of SGLT2i use, given its known renal benefits.