When an SGLT2 inhibitor is started, eGFR typically dips a little in the first weeks, which reflects a haemodynamic change in the glomerulus rather than kidney injury. A small, stable dip is not a reason to stop the drug.
Check creatinine and potassium a few weeks after starting, review fluid status and other drugs that lower pressure or volume, and look again if the fall is large, progressive, or accompanied by symptoms of volume depletion. Explain the dip to the patient beforehand so it does not trigger an unnecessary stop.
- Recheck creatinine and potassium a few weeks after starting.
- Do not stop for a small stable eGFR dip.
- Review diuretics and fluid status if the fall is large or the patient feels unwell.
- Warn the patient about the sick-day rules.
Why it matters
Stopping a protective drug because of an expected dip loses its long-term benefit.
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