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SGLT2i eGFR Slope Benefit — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseSGLT2i eGFR Slope BenefitESENeph

A 60-year-old man with diabetic CKD G4 has been on an ACEi for 10 years. Despite good BP control, his eGFR has declined from 40 to 22 over 3 years. His uACR is 180 mg/mmol. He is on Dapagliflozin. The annual rate of eGFR decline before SGLT2i was -6 mL/min/year. After starting Dapagliflozin, the slope has reduced to -2 mL/min/year. What does this change represent?

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Correct answer: E — Clinically significant slowing of CKD progression – SGLT2i reduces the rate of eGFR decline (slope), delaying the time to kidney failure by years even though eGFR continues to fall

SGLT2i therapy characteristically reduces the slope of eGFR decline – the rate at which kidney function is lost over time. Even a modest reduction in slope (e.g. from -6 to -2 mL/min/year) translates into years of delayed kidney failure and dialysis avoidance. The initial haemodynamic eGFR dip does not negate this benefit. Post-hoc analyses from DAPA-CKD showed that the eGFR slope benefit was consistent across all subgroups. KDIGO 2024 recommends continuing SGLT2i even as eGFR falls below 20, unless not tolerated or dialysis starts.

Reference: KDIGO 2024 – CKD; Heerspink et al 2020 – DAPA-CKD Slope Analysis