SGLT2 inhibitors and RAS blockers lower intraglomerular pressure, which causes a small early fall in eGFR. This haemodynamic dip is part of how they protect the kidney, and stopping the drug because of it throws away long-term benefit.
A rise in creatinine of up to about 30% in the first weeks is generally acceptable. Larger rises, or falling urine output, call for a look for volume depletion, NSAIDs, or renal artery stenosis.
- Recheck creatinine and potassium one to four weeks after starting or increasing an ACE inhibitor, ARB or SGLT2 inhibitor.
- Accept a creatinine rise of up to about 30% without stopping the drug.
- If the rise is larger, look for dehydration, NSAIDs or diuretic excess before stopping.
- Pause these drugs during acute illness with vomiting or poor intake, and restart on recovery.
Why it matters
Premature stopping after an expected dip is a common reason patients lose kidney protection.
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