A known case of chronic kidney disease stage 4 is on insulin therapy. What adjustment in insulin dosage is required?: (A) Increase dose of insulin, (B) Decrease dose of insulin, (C) Variable, (D) No alteration in dose
Answer is B. Some of the insulin is cleared by the kidneys. No dose adjustment is required if GFR is more than 50 mL/min. If GFR is less than 50 mL/min, then insulin dose should be reduced. As in CKD stage 4 GFR is <15mL/min so the dose of insulin should be decreased.