Dosing of Gliclazide MR in Chronic Kidney Disease (CKD)
Gliclazide MR can be safely used in patients with CKD at all stages without dose adjustment due to its hepatic metabolism with minimal renal excretion. 1
Pharmacokinetics and Safety Profile
- Gliclazide undergoes primarily hepatic metabolism with minimal renal excretion, making it suitable for use in advanced CKD 1
- Unlike other sulfonylureas such as glyburide (which should be avoided in CKD), gliclazide does not significantly accumulate in renal impairment 2, 1
- The modified release (MR) formulation provides consistent 24-hour glycemic control with once-daily dosing 3
Dosing Recommendations by CKD Stage
- Initial dosing: Start with 40-80 mg daily of gliclazide MR in patients with CKD 1
- CKD stages 1-3: No dose adjustment required (eGFR >30 mL/min/1.73m²) 2, 1
- CKD stages 4-5: No dose adjustment required, but consider starting at the lower end of the dosing range (40 mg daily) to minimize hypoglycemia risk 2, 1
- Maintenance dosing: Can be titrated up to 120 mg daily based on glycemic response and tolerability 4
Monitoring Recommendations
- Check blood glucose more frequently after initiation or dose changes in CKD patients 1
- Monitor for signs and symptoms of hypoglycemia, which may be more prolonged in CKD 1
- Consider more frequent monitoring in elderly patients with advanced CKD (stages 4-5), who are at higher risk of hypoglycemia 1
Advantages in CKD Population
- Lower risk of hypoglycemia compared to other sulfonylureas, particularly in patients with impaired renal function 4, 5
- Clinical studies have shown a low incidence of hypoglycemic episodes (4.8 episodes/100 patient-years) with no severe episodes, even in elderly patients and those with impaired renal function 4
- No significant weight gain compared to some other sulfonylureas 3, 6
Alternative Considerations
- For patients with CKD and type 2 diabetes, SGLT2 inhibitors (if eGFR ≥20 mL/min/1.73m²) or GLP-1 receptor agonists may be preferred agents due to their proven kidney and cardiovascular benefits 2
- If using gliclazide MR in combination with SGLT2 inhibitors, monitor for potential hypoglycemia and adjust doses accordingly 1
Cautions
- Despite its favorable profile in CKD, be aware that massive overdose of gliclazide has been associated with acute renal failure in case reports 7
- Temporarily suspend during acute illness, similar to other antidiabetic medications 2
In summary, gliclazide MR is a suitable sulfonylurea for patients with CKD at all stages, with no dose adjustment required due to its predominantly hepatic metabolism and minimal renal excretion.