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SGLT2i Stop During Perineal Infection — ESENeph MCQ

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EasyAcute Kidney InjurySGLT2i Stop During Perineal InfectionESENeph

A 50-year-old man with CKD G3b on Dapagliflozin develops a perineal abscess requiring surgical drainage. His surgeon asks whether Dapagliflozin should be stopped. What is the advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Stop Dapagliflozin during the acute infection and perioperative period – glycosuria may impair local immune defence and wound healing; restart once the infection has resolved and the wound is healing

SGLT2i should be temporarily withheld during acute infections (particularly genitourinary and perineal) and perioperatively. Glycosuria creates a glucose-rich environment favouring bacterial growth in the urogenital region. Additionally, perioperative SGLT2i use carries euglycaemic DKA risk (fasting + metabolic stress). MHRA and FDA have issued alerts about Fournier gangrene association with SGLT2i. The drug should be restarted once the infection is resolved, the wound is healing, and the patient is eating normally – the long-term renoprotective benefits warrant resumption.

Reference: MHRA 2019 – SGLT2i Safety; KDIGO 2024 – CKD