A 52-year-old man with Type 2 diabetes is on metformin 2 g/day and his HbA1c is 8.4%. He has eGFR of 28 mL/min/1.73m². Which medication should be AVOIDED in adding to his regimen?
- A Empagliflozin ✓
- B Sitagliptin (dose-adjusted)
- C Linagliptin
- D Insulin glargine
Correct answer: A. Empagliflozin
Explanation
SGLT2 inhibitors (empagliflozin) require adequate renal glucose filtration to work; they are ineffective and not recommended when eGFR < 30 mL/min/1.73m². DPP-4 inhibitors like sitagliptin can be used with dose adjustment (25 mg OD at eGFR < 30), while linagliptin requires no dose adjustment at any eGFR level. Insulin is safe across all CKD stages.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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