Which hypoglycaemic agents to use in type 2 diabetic subjects with CKD and how?

would obviously be of paramount importance. In the study by Liu et al. [9], hypovolaemia was identified in only 20% of patients, but identifying hypovolaemia retrospectively is difficult so this number may not be accurate. In the clinical situation, assessing ongoing fluid needs and responsiveness is complex as physicians balance the risks of fluid overload with those of hypovolaemia. Second, should vasopressors be used to restore baseline blood pressure or limit the risks of hypotension? This is a controversial area but there is no good evidence that liberal use of vasopressors decreases the incidence of acute renal failure. Finally, what level of arterial pressure should be chosen as the target? Finding one value that could be applicable to all patients would be difficult, perhaps such a value should be related to the patient’s own baseline blood pressure value which may be unknown. Clearly, even if relative hypotension does participate in the development of acute renal failure, focusing primarily on arterial blood pressure as a target may be rather limited. Rather than providing a new goal, these observations by Liu et al. [9] are more a message supporting the importance of early, rapid and complete resuscitation in all patients.