SGLT2 inhibitors lower glomerular pressure, and eGFR usually falls slightly in the first weeks of treatment. This haemodynamic dip is expected, generally modest, and in outcome trials was followed by slower long-term decline.
Established practice is to recheck kidney function a few weeks after starting, continue the drug through a modest dip, and look for another cause — volume depletion, interacting drugs or obstruction — if the fall is large or progressive.
- Warn patients and colleagues that a small eGFR fall after starting an SGLT2 inhibitor is expected.
- Recheck creatinine a few weeks after starting.
- Do not stop the drug for a modest early dip alone.
- Look for volume depletion or other causes if the fall is large or continues.
Why it matters
Stopping for an expected dip throws away long-term kidney protection.
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