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Lifelong RASi SGLT2i CKD — ESENeph MCQ

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EasyChronic Kidney DiseaseLifelong RASi SGLT2i CKDESENeph

A 40-year-old man with CKD G3a from IgA nephropathy has been adherent to RASi and SGLT2i for 2 years. His eGFR is stable at 55 and proteinuria has fallen from 1.5 to 0.3 g/day. He asks how long he needs to stay on these medications. What is the answer?

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Correct answer: D — These medications should be continued indefinitely – their benefits are ongoing through continuous pharmacological mechanisms; stopping leads to rebound proteinuria and loss of protection

RASi and SGLT2i provide ongoing renoprotection through continuous pharmacological mechanisms: RASi reduces intraglomerular pressure (efferent arteriolar dilation); SGLT2i reduces it further (afferent constriction via TGF). These effects cease when the drugs are stopped. Post-hoc analyses from DAPA-CKD show that eGFR decline returns to the pre-treatment trajectory when SGLT2i is withdrawn. Similarly, proteinuria rebounds when RASi is stopped. Therefore, these agents should be continued indefinitely unless specific contraindications develop. This mirrors the concept of cardiovascular medications (statins, antihypertensives) being lifelong.

Reference: KDIGO 2024 – CKD; DAPA-CKD Post-Hoc Analyses