A review of the expanding applications of SGLT2 inhibitors in chronic kidney disease and heart disease

1. In Canada, approximately what proportion of people living with CKD do not have T2DM?

a. 30%
b. 40%
c. 50%
d. 60%

2. Based on the evidence of SGLT2i treatment in CKD, which scenario would be expected to derive the LEAST benefit from slowing kidney disease progression?

a. T2DM, eGFR 56 mL/min/1.73 m2, uACR 92 mg/mmol
b. Hypertension, eGFR 43 mL/min/1.73 m2, uACR 96 mg/mmol
c. Coronary artery disease, eGFR 32 mL/min/1.73 m2, uACR 41 mg/mmol
d. HFpEF, eGFR 65 mL/min/1.73 m2, uACR 10 mg/mmol

3. In the SGLT2i trials that investigated heart failure outcomes, which outcome had the most consistent, compelling evidence?

a. Reduce risk of heart failure hospitalization
b. Reduce risk of cardiovascular mortality
c. Reduce combined risk of myocardial infarction, stroke, and heart failure exacerbation
d. Reduce risk of all-cause mortality

4. Which of the following SGLT2i had a landmark study that demonstrated kidney benefits (e.g. slowed progression to ESKD and cardiovascular death) and safety in a CKD population with an eGFR as low as 20 mL/min/1.73 m² and absence of diabetes?

a. Canagliflozin
b. Dapagliflozin
c. Empagliflozin
d. All the above

5. What is a potential effect of SGLT2i beyond glucose-lowering that is thought to protect the heart and kidneys?

a. Reduce inflammation to the heart and kidney tissues
b. Increase diuresis which leads to increased blood pressure
c. Increase oxidative stress to the cardiac muscle cells
d. Decrease natriuresis which leads to increased albuminuria

6. By restoring tubulo-glomerular feedback, how do SGLT2i reduce intraglomerular pressure?

a. Vasodilation of the efferent arterioles
b. Vasodilation of the afferent arterioles
c. Vasoconstriction of the efferent arterioles
d. Vasoconstriction of the afferent arterioles

7. What is the most common side effect associated with SGLT2 inhibitors?

a. Urinary tract infections
b. Acute kidney injury
c. Mycotic genital infections
d. Hypoglycemia

8. What is a risk factor that increases the risk of diabetic ketoacidosis associated with SGLT2i?

a. Urinary tract infections
b. Acute illness (i.e., vomiting and diarrhea)
c. Hypoglycemia
d. High blood pressure

9. Upon initiation of an SGLT2i, the serum creatinine is expected to risk which will cause a decline in eGFR. Up to what percentage decline of eGFR is acceptable with close monitoring?

a. 10%
b. 20%
c. 30%
d. 40%

10. Which of the following scenario would an SGLT2i not be recommended given insufficient data available to support its use at present?

a. Patient with CKD secondary to hypertension with an eGFR 25 mL/min/1.73 m2 and uACR 3 mg/mmol
b. Patient who started empagliflozin for HFpEF and CKD with an eGFR 25 mL/min/1.73 m2 three years ago and their current eGFR is 18 mL/min/1.73 m2 not on dialysis
c. Patient with T2DM (HgbA1c 9.5%) and ESKD on peritoneal dialysis
d. Patient with HFpEF, eGFR 87 mL/min/1.73 m2, and uACR < 1 mg/mmol

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