A 72-year-old man with type 2 diabetes and an eGFR of 30 mL/min/1.73 m² has erratic postprandial glucose spikes. The physician chooses repaglinide over a sulfonylurea. The rationale for preferring repaglinide in renal impairment is that it is:

• A Renally excreted unchanged and therefore safe in CKD
• B A DPP-4 inhibitor that does not require dose adjustment in any stage of CKD
• C Metabolized primarily by the liver to inactive metabolites with minimal renal excretion ✓
• D An alpha-glucosidase inhibitor that acts locally in the gut

Explanation

Repaglinide is a meglitinide that is extensively metabolized by the liver via CYP3A4 and CYP2B8 to inactive metabolites, with less than 8% renal excretion. It can therefore be used with caution in renal impairment without dose adjustment, unlike glyburide which accumulates and causes dangerous hypoglycemia in CKD.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.