Chronic Kidney Disease with Diabetes — SCE Endocrinology MCQ

Correct answer: A — SGLT2 inhibitor

The correct answer is A, SGLT2 inhibitor. This patient has type 2 diabetes with CKD (eGFR 42 mL/min/1.73 m2) and an ACR of 320 mg/g (equivalent to roughly 36 mg/mmol), placing them firmly in the range where NICE recommends offering an SGLT2 inhibitor in addition to an ACE inhibitor as disease-modifying therapy. NICE NG28 states that an SGLT2 inhibitor should be offered when ACR is above 30 mg/mmol (and considered between 3 and 30 mg/mmol), reflecting robust trial evidence (DAPA-CKD, CREDENCE) that these agents slow eGFR decline, reduce progression to end-stage kidney disease, and lower cardiovascular death independent of glycaemic effect, via reduction of intraglomerular pressure and albuminuria. This mechanism is additive to ACE inhibition and is licensed down to an eGFR of 25 mL/min/1.73 m2 for dapagliflozin, so this patient's eGFR of 42 is well within range for initiation.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal-nutritional-and-metabolic-conditions