These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

December 04, 2024

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The guideline on use of sodium-glucose cotransporter–2 (SGLT-2) inhibitors in adults with chronic kidney disease (CKD) was released on October 1, 2024 by an international panel.^[1]

The guideline panel suggests administering SGLT-2 inhibitors in adults with CKD who are at low or moderate risk of CKD progression and complications.

The guideline panel strongly recommends administering SGLT-2 inhibitors in adults with CKD who are at high or very risk of CKD progression and complications.

The beneficial effects of SGLT-2 inhibitors are considered to be class effects, so all SGLT-2 inhibitors are considered similarly.

SGLT-2 inhibitors may be initiated at the highest possible dose and do not require dose titration.

SGLT-2 inhibitors may be initiated in adults with estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m². Once initiated, SGLT-2 inhibitors may be continued even if eGFR falls below 20 mL/min/1.73m², until dialysis initiation.

SGLT-2 inhibitors are likely to cause an acute transient decline in GFR within two to four weeks after initiation. However, it is not routinely necessary to check eGFR, except in high-risk individuals such as those with prior acute kidney injury or at risk of volume depletion. SGLT-2 therapy need not be discontinued unless the decline in eGFR exceeds 25% from baseline. If treatment is discontinued, another attempt to initiate therapy may be pursued after recovery of kidney function.

Individuals who are already taking diuretics or are otherwise at risk of volume depletion may require closer monitoring and diuretic titration when initiating SGLT-2 inhibitors. This may be particularly pertinent with exposure to hot weather.

In individuals with concomitant heart failure, SGLT-2 inhibitors should be initiated irrespective of kidney function and degree of albuminuria.

For more information, see Chronic Kidney Disease (CKD). For more Clinical Practice Guidelines, please go to Guidelines.