Sodium Glucose Transportase Inhibitors (SGLT2i)

Whilst initially developed to treat hyperglycaemia, SGLT2i have become a key therapy for the management of CKD. They significantly reduce the risk of progression of kidney disease in patients with type 2 diabetes and proteinuric, non-diabetic CKD.

Recommended by NICE to be commenced in people with CKD regardless of presence of type 2 diabetes

Dapagliflozin for treating CKD – NICE TA 1075
Empagliflozin for treating CKD – NICE TA 942
NICE Guidelines: Type 2 diabetes in adults: management – NG28

They should be added to ACEi/ARB (or initiated without ACEi/ARB if the latter is contraindicated or not tolerated — continue to pursue other components of the ladder including statin and finerenone where eligible).

SGLT2i have been shown to reduce the risk of serious adverse cardiovascular events, hospitalisation with heart failure, and all-cause mortality in CKD.

Renin-Angiotensin System (RAS) Inhibitors

nsMRA (finerenone)