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CKD progression slowing — ABIM Board MCQ

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HardNephrologyCKD progression slowingABIM Board

A 63-year-old with diabetic CKD has eGFR 38 mL/min/1.73 m2, UACR 680 mg/g and potassium 4.5 mEq/L despite maximal losartan and an SGLT2 inhibitor. Which additional treatment is appropriate?

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

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Correct answer: E — Add finerenone with early potassium and kidney-function monitoring

The best answer is “Add finerenone with early potassium and kidney-function monitoring”. Finerenone reduces kidney and cardiovascular events in eligible albuminuric diabetic CKD despite optimized RAS and SGLT2 therapy when potassium is normal. Potassium must be monitored because hyperkalemia can limit treatment. Dual ACE inhibitor and ARB therapy is harmful, and persistent residual albuminuria is not a reason to abandon SGLT2 benefit.

Reference: KDIGO 2024 Clinical Practice Guideline for Chronic Kidney Disease: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf