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DKD with Heart Failure — ESENeph MCQ

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ModerateChronic Kidney DiseaseDKD with Heart FailureESENeph

A 55-year-old man with type 2 diabetes, CKD G3bA3, and heart failure with reduced ejection fraction (LVEF 35%) is on Ramipril, Bisoprolol, and Spironolactone. His eGFR is 38 mL/min/1.73m2, K+ 4.8 mmol/L. Which additional medication has the strongest evidence for kidney and cardiac protection?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Dapagliflozin

KDIGO 2024 recommends SGLT2i (1A) for patients with T2D and CKD with eGFR ≥20, and also for patients with heart failure irrespective of albuminuria (1A). DAPA-HF and EMPEROR-Reduced showed SGLT2i reduces heart failure hospitalisations and CV death in HFrEF. The dual kidney-cardiac benefit makes this the strongest evidence-based addition. Finerenone should not be added on top of Spironolactone due to hyperkalaemia risk.

Reference: KDIGO 2024 – CKD Guideline; ESC 2023 – Heart Failure Guidelines