Practice Point 4.2.2:
For patients in whom additional glucose-lowering may increase risk for hypoglycemia (e.g., those treated with insulin or sulfonylureas and currently meeting glycemic targets), it may be necessary to stop or reduce the dose of an antihyperglycemic drug other than metformin to facilitate addition of an SGLT2i.
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Diabetes in CKD: Visual Guidelines |
Practice Point 4.2.4:
It is reasonable to withhold an SGLT2i during times of prolonged fasting, surgery, or critical medical illness (when patients may be at greater risk for ketosis).
Practice Point 4.2.6:
A reversible decrease in the eGFR with commencement of SGLT2i treatment may occur and is generally not an indication to discontinue therapy.
Practice Point 4.2.7:
Once an SGLT2i is initiated, it is reasonable to continue an SGLT2i even if the eGFR falls below 30 mL/min/1.73 m², unless it is not tolerated or kidney replacement therapy is initiated.
Practice Point 4.2.1:
An SGLT2i can be added to other antihyperglycemic medications for patients whose glycemic targets are not currently met or who are meeting glycemic targets but can safely attain a lower target.
Based on DAPA-CKD and the forthcoming EMPA-KIDNEY trial, the GFR threshold at which SGLT2i can be initiated will be reassessed in future guideline updates.
Practice Point 4.2.3:
Choice of an SGLT2i should prioritize agents with documented kidney or cardiovascular benefits and take eGFR into account.
The published results from DAPA-CKD, VERTIS-CV, SCORED, SOLOIST trials will be formally assessed in the next guideline update. Data from the ongoing EMPA-KIDNEY are also awaited.
Practice Point 4.2.8:
SGLT2i have not been adequately studied in kidney transplant recipients, who may benefit from SGLT2i treatment, but are immunosuppressed and potentially at increased risk for infections; therefore, the recommendation to use SGLT2i does not apply to kidney transplant recipients.
Based on DAPA-CKD and the forthcoming EMPA-KIDNEY trial, the GFR threshold at which SGLT2i can be initiated will be reassessed in future guideline updates.