Question

A 59-year-old with type 2 diabetes and CKD has eGFR 48 mL/min/1.73 m2 and urine albumin-to-creatinine ratio 450 mg/g while on a maximally tolerated ACE inhibitor. Blood pressure and A1C are reasonable. What medication class should be added to slow CKD progression and reduce cardiovascular risk?

Accepted Answer

SGLT2 inhibitor (e.g., empagliflozin) if eGFR at least 20 mL/min/1.73 m2

Answer

Thiazolidinedione (pioglitazone)

Answer

GLP-1 receptor agonist as sole addition

Answer

DPP-4 inhibitor (sitagliptin)

Answer

Increase ACE inhibitor dose above the maximum

Practice question

A 59-year-old with type 2 diabetes and CKD has eGFR 48 mL/min/1.73 m2 and urine albumin-to-creatinine ratio 450 mg/g while on a maximally tolerated ACE inhibitor. Blood pressure and A1C are reasonable. What medication class should be added to slow CKD progression and reduce cardiovascular risk?