KDIGO 2022 guidelines now recommend which medication as first-line for slowing CKD progression in patients with CKD and albuminuria (ACR ≥ 30 mg/g), regardless of whether they have heart failure or T2DM?
- A Finerenone (non-steroidal MRA)
- B Renin-angiotensin system blockers (ACE inhibitor or ARB) only
- C SGLT2 inhibitors (empagliflozin or dapagliflozin) ✓
- D Spironolactone for all CKD patients with proteinuria
Correct answer: C. SGLT2 inhibitors (empagliflozin or dapagliflozin)
Explanation
The CREDENCE, DAPA-CKD, and EMPA-KIDNEY trials demonstrated that SGLT2 inhibitors significantly reduce the composite of CKD progression, ESKD, and CV death in patients with CKD and albuminuria ≥200 mg/g, independent of diabetes status. KDIGO 2022 CKD guidelines now recommend SGLT2 inhibitors (dapagliflozin or empagliflozin) as first-line nephroprotective therapy on top of RAAS blockade in CKD with eGFR ≥20 and ACR ≥200 mg/g. Finerenone has evidence in diabetic CKD specifically (FIDELIO-DKD, FIGARO-DKD).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.