SGLT2i Dual CKD HFpEF Benefit — ESENeph MCQ

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ModerateChronic Kidney DiseaseSGLT2i Dual CKD HFpEF BenefitESENeph

A 65-year-old woman with CKD G3b (eGFR 36 mL/min/1.73m2) and heart failure with preserved ejection fraction (HFpEF) is on ramipril 10 mg, bisoprolol 5 mg, and furosemide 40 mg. She remains breathless on exertion with ankle oedema. Which drug class has evidence for benefit in BOTH CKD progression and HFpEF?

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Correct answer: D — SGLT2 inhibitors

SGLT2 inhibitors have demonstrated benefit in both CKD progression (DAPA-CKD, EMPA-KIDNEY) AND HFpEF (EMPEROR-Preserved, DELIVER). This unique dual benefit makes them the ideal addition for this patient. Empagliflozin (EMPEROR-Preserved) and dapagliflozin (DELIVER) both reduced heart failure hospitalisations in HFpEF patients regardless of diabetes status. Simultaneously, these drugs slow eGFR decline and reduce kidney events. The mechanism involves reduced preload/afterload, improved cardiac energetics, and nephroprotective effects via tubuloglomerular feedback modulation. This convergence of cardiorenal benefit represents a paradigm shift in managing the overlap of CKD and HFpEF.

Reference: Anker et al 2021 – EMPEROR-Preserved; Solomon et al 2022 – DELIVER; KDIGO 2024 – CKD Guideline