Program

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Clinical Implications of an Acute Dip in eGFR after SGLT2 Inhibitor Initiation

May 26, 2023 from 11:25am EDT to 11:55am EDT

Treatment with sodium-glucose co-transporter-2 inhibitors (SGLT2I)) is associated with an average initial decrease of 3–5 ml/min/1.73 m2 in the estimated glomerular filtration rate (eGFR). Although the decline is considered hemodynamic in origin and reversible, the ‘eGFR dip’ raises concerns in clinical practice, highlighting the need to understand its mechanism and clinical implications. The dip in eGFR leads some clinicians to discontinue evidence-based and lifesaving treatments such as renin-angiotensin system blockers or mineralocorticoid receptor antagonists, thus creating clinical inertia. Clinicians associate an acute decline in eGFR with a risk of acute kidney injury or progressive worsening of kidney function, resulting in the underuse of SGLT2I. In Canada, diabetes is the major cause of kidney disease as individuals with uncontrolled chronic hyperglycemia develop vasodilation of the afferent arterioles leading to renal hyperfiltration and increased intraglomerular pressure. Increased intraglomerular pressure is an essential contributor to the pathogenesis and progression of CKD, leading to progressive scarring and a vicious cycle of renal fibrosis. SGLT2I are a class of drugs that, in addition to their cardiovascular protective effects, reduce kidney disease progression in patients with diabetes by reducing intraglomerular pressure. Clinical studies on SGLT2I have provided essential insights into the mechanisms and clinical relevance of the eGFR dip. The purpose of this presentation is to discuss the clinical implications of an acute dip in eGFR after SGLT2I  initiation. The presenters will provide participants with practical tips to identify situations that warrant immediate attention and intervention to prevent a further drop in eGFR.

Speakers / Panelists

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    Mohamed Toufic El Hussein
    PhD NP

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    Nancy Clark
    MN ACNP CCN(C)