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Diabetic Nephropathy — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseDiabetic NephropathyESENeph

A 40-year-old man with type 2 diabetes has eGFR 28 mL/min/1.73m2 and uACR 180 mg/mmol. He is on maximum Losartan and Dapagliflozin. HbA1c is 72 mmol/mol despite Metformin 1 g BD (maximum tolerated). According to KDIGO 2024, what is the recommended next glycaemic agent?

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Correct answer: D — Long-acting GLP-1 receptor agonist (e.g. Semaglutide)

KDIGO 2024 recommends (1B) a long-acting GLP-1 RA for adults with T2D and CKD who have not achieved glycaemic targets despite metformin and SGLT2i. The guideline states the choice should prioritise agents with documented cardiovascular benefits (e.g. Semaglutide, Liraglutide). GLP-1 RAs provide additional CV protection and weight management benefits. Sulfonylureas increase hypoglycaemia risk in CKD.

Reference: KDIGO 2024 – CKD Guideline