Meeting a Proposed Estimated Glomerular Filtration Rate Slope-Based Criterion for Clinical Remission of Chronic Kidney Disease During Sequential Kidney-Protective Therapy in Type 2 Diabetes Mellitus: A Case Report

Background: A recently proposed estimated glomerular filtration rate (eGFR) slope-based criterion for clinical remission of chronic kidney disease (CKD) represents an emerging therapeutic paradigm. However, clinical courses meeting this criterion after sequential combination therapy with kidney-protective agents have rarely been reported in patients with type 2 diabetes mellitus (T2DM) and CKD. Case Presentation: A 70-year-old man with long-standing T2DM, nonproliferative diabetic retinopathy, and progressive albuminuric CKD presented in May 2023 with a urine albumin-to-creatinine ratio (UACR) of 121.60 mg/g creatinine (Cr), an eGFR of 28.00 mL/min/1.73 m2, hemoglobin A1c (HbA1c) of 7.5%, and serum potassium of 4.4 mmol/L. Kidney function had continued to decline despite treatment with a renin-angiotensin system inhibitor (RASi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), and insulin. Therapy was sequentially intensified with a glucagon-like peptide-1 receptor agonist (GLP-1RA) and finerenone, with close monitoring of kidney function and serum potassium. By January 2026, UACR had decreased to 26.53 mg/g Cr and eGFR had increased to 42.48 mL/min/1.73 m2. No adverse event required treatment discontinuation. Results: Ordinary least-squares regression of all 10 eGFR measurements yielded a positive slope that met the recently proposed eGFR slope-based criterion for clinical remission of CKD. Conclusions: In this patient with T2DM and CKD, the eGFR slope over the full follow-up met the proposed criterion for clinical remission of CKD during sequential multidrug kidney-protective therapy with safety monitoring. These observations require confirmation in prospective controlled studies.