Diabetic Kidney Disease — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesDiabetic Kidney DiseaseRACP Adult Medicine

A 60-year-old man with type 2 diabetes and CKD stage 3b (eGFR 38 mL/min/1.73 m²) has an HbA1c of 62 mmol/mol on metformin 1 g BD. His urine ACR is 45 mg/mmol. According to KDIGO/CARI guidelines, which additional agent provides the most cardiovascular and renal benefit?

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Correct answer: A — Empagliflozin

KDIGO and CARI guidelines recommend SGLT2 inhibitors for patients with type 2 diabetes and CKD (eGFR ≥20 mL/min/1.73 m²) to reduce CKD progression and cardiovascular events, independent of glycaemic control. Empagliflozin (EMPA-REG) and dapagliflozin (DAPA-CKD) have shown renal and cardiovascular benefits. The eGFR threshold for initiation has been lowered to ≥20 mL/min/1.73 m².

Reference: KDIGO – 2024 – Diabetes in CKD; KHA-CARI – 2024 – Commentary on KDIGO DM-CKD Guideline