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SGLT2i Continuation in Advanced CKD — RACP Adult Medicine MCQ

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ModerateNephrologySGLT2i Continuation in Advanced CKDRACP Adult Medicine

A 55-year-old woman with type 2 diabetes and CKD stage G4 (eGFR 18 mL/min/1.73m²) is on perindopril 10 mg, empagliflozin 10 mg, and insulin. Her proteinuria persists (ACR 120 mg/mmol). She is approaching ESKD. Should empagliflozin be continued?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Continue empagliflozin

SGLT2 inhibitors can be continued once initiated even as eGFR declines below 20 mL/min/1.73m², as their cardiorenal benefits persist. Per KDIGO 2024 and DAPA-CKD/EMPA-KIDNEY, SGLT2i should only be stopped at dialysis initiation or transplant. They should not be newly started below eGFR 20 but can be continued if already established.

Reference: KDIGO – 2024 – CKD Guidelines; DAPA-CKD Trial