During acute illness with vomiting, diarrhoea, fever or poor intake, several common drugs raise the risk of acute kidney injury or metabolic complications. SGLT2 inhibitors, ACE inhibitors and ARBs, diuretics, metformin and NSAIDs are the usual group — sometimes remembered as 'SADMANS'.
Patients should be told in advance to pause these temporarily when they cannot keep fluids down, and to restart once eating and drinking normally, usually after 24 to 48 hours. NSAIDs are best avoided altogether in CKD. Written instructions work better than verbal advice given once.
- Advise pausing SGLT2 inhibitors, ACE inhibitors, ARBs, diuretics and metformin during dehydrating illness.
- Tell patients to restart once eating and drinking normally for 24–48 hours.
- Advise avoiding NSAIDs in CKD.
- Give the guidance in writing and repeat it at reviews.
Why it matters
Most drug-related acute kidney injury happens at home during intercurrent illness.
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