SGLT2 inhibitors reduce intraglomerular pressure, which causes an early, usually reversible fall in eGFR in the first few weeks — often a few ml/min/1.73 m². This haemodynamic dip is part of how they protect the kidney long term, and trials showed benefit despite it.
The dip is not a reason to stop. A fall larger than about 30%, or one with volume depletion, does warrant a review of diuretics, blood pressure and other nephrotoxins.
- Warn patients and colleagues that a small early eGFR fall is expected.
- Recheck kidney function a few weeks after starting.
- Do not stop for a modest dip; review if the fall exceeds about 30%.
- Consider reducing diuretics if the patient is volume depleted.
- Advise sick-day rules: pause during dehydrating illness.
Why it matters
Stopping an SGLT2 inhibitor because of the expected early dip throws away its long-term kidney protection.
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