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SGLT2i Initial eGFR Dip Haemodynamic — ESENeph MCQ

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EasyDiabetic Kidney DiseaseSGLT2i Initial eGFR Dip HaemodynamicESENeph

A 56-year-old man with diabetes and CKD G3a (eGFR 55 mL/min/1.73m2) is started on dapagliflozin 10 mg. After 2 weeks, his eGFR drops from 55 to 48 mL/min/1.73m2. He feels well. BP is 124/76 mmHg. What is the most appropriate action?

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Correct answer: E — Continue dapagliflozin unchanged — this is an expected haemodynamic effect

An initial eGFR dip of up to 10-15% on starting SGLT2i is an expected haemodynamic effect resulting from afferent arteriolar vasoconstriction and reduced glomerular hyperfiltration (mediated by tubuloglomerular feedback from increased sodium delivery to the macula densa). This dip is analogous to the eGFR dip seen with RASi initiation and is NOT harmful — in fact, it reflects the mechanism by which SGLT2i confer long-term nephroprotection. The DAPA-CKD and EMPA-KIDNEY trials confirmed that patients who experienced an initial eGFR dip had the same long-term benefit as those who did not. The drug should be continued and eGFR monitored at 4-6 weeks.

Reference: KDIGO 2024 – CKD Guideline; Heerspink et al 2021 – DAPA-CKD; EMPA-KIDNEY Collaborative