CKD (SGLT2 threshold) — ESENeph MCQ

Correct answer: A — Initiate SGLT2 inhibition at an eGFR of 21

The best answer is “Initiate SGLT2 inhibition at an eGFR of 21”. The eGFR threshold for cardiorenal benefit is lower than older glycaemic licensing cut-offs. Agent-specific product information and clinical status still guide selection, but eGFR 21 is within the recommended initiation range. “SGLT2 inhibition requires eGFR at least 45 mL/min/1.73m²” is less appropriate because this obsolete glucose-lowering threshold does not define current cardiorenal initiation “SGLT2 inhibition requires eGFR at least 30 mL/min/1.73m²” is less appropriate because current kidney guidance supports initiation down to eGFR 20 “SGLT2 inhibition is withheld because heart failure removes kidney benefit” is less appropriate because heart failure is an additional indication rather than an exclusion “SGLT2 inhibition begins after kidney replacement therapy starts” is less appropriate because the evidence-based initiation window is before dialysis-dependent kidney failure

Reference: UK Kidney Association SGLT2 recommendations: https://guidelines.ukkidney.org/sodium-glucose-co-transporter-2/3-2-recommendations-for-use/