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SGLT2i in CKD — EECC MCQ

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EasyHypertension & Preventive CardiologySGLT2i in CKDEECC

A 60-year-old man with hypertension, diabetes, CKD stage 3b (eGFR 35), and proteinuria (ACR 300 mg/g) is on ramipril 10 mg. What additional agent has strong evidence for cardiorenal protection?

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Correct answer: C — SGLT2 inhibitor (dapagliflozin or empagliflozin) — provides independent cardiorenal protection in CKD with or without diabetes, reducing progression to ESKD and cardiovascular events

SGLT2 inhibitors have demonstrated robust cardiorenal protection across multiple landmark trials: DAPA-CKD (dapagliflozin in CKD with eGFR 25-75), EMPA-KIDNEY (empagliflozin in broader CKD population), CREDENCE (canagliflozin in diabetic nephropathy). Benefits include: 39% reduction in kidney disease progression (DAPA-CKD), significant reduction in CV death and HF hospitalisation, and slowing of eGFR decline. Benefits are independent of diabetes status. The KDIGO 2024 Guidelines and ESC 2024 Hypertension Guidelines recommend SGLT2 inhibitors as foundational therapy in CKD alongside RAAS inhibitors (Class I, LOE A). Dual RAAS blockade (ACEi + ARB) is not recommended due to increased adverse effects without benefit (ONTARGET).

Reference: ESC (2024): Hypertension Guidelines; KDIGO 2024; DAPA-CKD/EMPA-KIDNEY Trials