5th May 2024

A 58-year-old woman with a history of type 2 diabetes and hypertension presents with fatigue and a reduced appetite.

A 58-year-old woman with a history of type 2 diabetes and hypertension presents with fatigue and a reduced appetite. Her current medications include metformin, lisinopril, and amlodipine. Her blood pressure is 142/88 mmHg. Laboratory investigations reveal a serum creatinine of 1.9 mg/dL, eGFR of 35 mL/min/1.73 m² (GFR category G3b), and a urinary albumin-to-creatinine ratio of 220 mg/g. Her HbA1c is 7.8%. She has no signs of fluid overload.

Which is the most appropriate next step in management?