A 74-year-old man with type 2 diabetes, hypertension and knee osteoarthritis is seen in follow-up for chronic kidney disease. He asks what he can do to protect his kidneys. His medications are ramipril 10 mg daily, metformin 1000 mg BID, amlodipine 10 mg daily, pantoprazole 40 mg daily and over-the-counter naproxen 500 mg BID for knee pain. He has no history of reflux, peptic ulcer disease or gastrointestinal bleeding. Laboratory results show creatinine 180 µmol/L (60-110), eGFR 34 mL/min/1.73 m² (greater than 60), potassium 4.5 mmol/L (3.5-5.0), urine albumin-to-creatinine ratio 52 mg/mmol (less than 2.0) and HbA1c 7.4%. On examination he is euvolemic with no peripheral edema.
| Heart rate | 76/min |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| O2 saturation | 98%, room air |
| Blood pressure | 140/82 mm Hg |
Question 1 of 30
Which of the following medication changes are most appropriate to slow progression of this patient's kidney disease?
Select 3. (0 / 3 selected)
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