Goal-Directed Therapy to Reduce Kidney and Cardiovascular Risk in Diabetic Kidney Disease (GOLD-STANDARD)

Inclusion Criteria 1. Age ≥ 18 years 2. T2DM 3. CKD (eGFR ≥ 25-60 mL/min/1.73 m² OR UACR ≥ 30 mg/g) - on screening labs 4. High Cardiovascular (CV) Risk: Defined as a history of prior myocardial infarction (MI), stroke, or peripheral artery disease (PAD), or the presence of cardiovascular risk factors, (specifically age 40 years or older and at least one of the following: cholesterol above target (LDL≥1.8 mmol/L OR on cholesterol lowering medication - within past 24 months), hypertension (≥130/80 mmHg or on BPLMs), or atrial fibrillation.) 5. Open to start new medications Exclusion Criteria: 1. Type 1 diabetes 2. HbA1c ≥10% within past 12 months 3. Serum potassium ≥ 5.2 mmol/L on screening labs 4. Baseline Blood Pressure (BP) \< 100/60 mmHg at screening 5. Treated with new or intensified immunosuppression therapy for new (or relapse/flare of pre-existing) kidney disease within the last 60 days 6. Kidney Transplant 7. In the opinion of the investigator, currently treated with maximum tolerated dose of ≥3 medication classes:: RASi, SGLT2i, nsMRA or GLP1RA 8. Currently prescribed all 4 medication classes : RASi, SGLT2i, nsMRA or GLP1RA 9. Intolerance or allergy to any of RASi, SGLT2i, nsMRA or GLP1RA 10. Known Heart Failure with Reduced Ejection Fraction (HFrEF) 11. Current pregnancy, lactation or women of childbearing potential, unless using highly effective contraception