SGLT2i Continuation Despite Good Glycaemia — ESENeph MCQ

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EasyDiabetic Kidney DiseaseSGLT2i Continuation Despite Good GlycaemiaESENeph

A 55-year-old man with CKD G3b and diabetes has an HbA1c of 48 mmol/mol on Metformin and Dapagliflozin. His diabetic control is excellent. His GP asks if he still needs Dapagliflozin given that his diabetes is well controlled. What is the correct advice?

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Correct answer: A — Continue dapagliflozin for cardiorenal protection

SGLT2i kidney-protective benefits are independent of glycaemic effect. The DAPA-CKD and EMPA-KIDNEY trials showed benefits in both diabetic and non-diabetic CKD. Dapagliflozin should be continued for its renoprotective and cardioprotective properties regardless of HbA1c. This is a common misconception – SGLT2i in CKD is not a diabetes drug that happens to protect kidneys; it is a kidney drug that happens to lower glucose. Stopping it would remove significant renal protection. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO 2024 – CKD Guideline; DAPA-CKD Trial – NEJM 2020: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf