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DKD Pillared Therapy — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesDKD Pillared TherapyRACP Adult Medicine

A 55-year-old man with type 2 diabetes and an eGFR of 28 mL/min/1.73 m² is on metformin 500 mg BD, empagliflozin 10 mg, and ramipril 10 mg. His HbA1c is 69 mmol/mol and urine ACR is 55 mg/mmol. His potassium is 4.0 mmol/L. According to KDIGO 2024, which agent should be added next?

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Correct answer: B — Finerenone

This patient with T2DM, CKD with albuminuria, on RASi and SGLT2i, with normal potassium, is an ideal candidate for finerenone. KDIGO 2024 recommends finerenone for patients with T2DM and CKD with residual albuminuria (UACR ≥30 mg/g) on maximised RASi, with eGFR ≥25 mL/min/1.73 m² and non-elevated potassium. The FIDELITY analysis confirmed cardiovascular and kidney benefits.

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