In chronic kidney disease with albuminuria, add an SGLT2 inhibitor to a maximally tolerated renin-angiotensin system blocker (an ACE inhibitor or ARB), which is now standard to slow progression and reduce cardiovascular risk, in people with and without type 2 diabetes who meet eGFR criteria.
Counsel patients about the expected small, reversible drop in eGFR after starting, which is not a reason to stop, and give sick-day advice to hold the SGLT2 inhibitor during acute illness, dehydration or before major surgery because of the euglycaemic ketoacidosis risk. Check that the combination and blood pressure are tolerated, and continue the RAS blocker unless hyperkalaemia or a large creatinine rise dictates otherwise.
- Add an SGLT2 inhibitor to a maximally tolerated ACE inhibitor or ARB in albuminuric CKD.
- It benefits people with and without diabetes who meet eGFR criteria.
- Warn of a small, reversible eGFR dip after starting; it is not a reason to stop.
- Give sick-day rules: hold the SGLT2 inhibitor in acute illness or before major surgery.
Why it matters
This combination is now the backbone of slowing CKD progression, yet the SGLT2 inhibitor is still often omitted.
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