Herts KidneyCare

Should I be taking an SGLT2 inhibitor?

What is an SGLT2 Inhibitor?
SGLT2 inhibitors, such as Dapagliflozin, are medications used to manage blood sugar levels in individuals with diabetes. These medications work by helping your kidneys remove excess glucose (sugar) from your blood and expel it through your urine.

Why Have You Been Prescribed an SGLT2 Inhibitor (SGLT2i)?
-Your healthcare provider may prescribe an SGLT2i as part of your CKD management plan. These medications have shown benefits for people with CKD by potentially reducing the risk of cardiovascular events, slowing down the progression of kidney disease, and managing blood sugar levels. SGLT2 inhibitors are recommended for a variety of people with CKD, whether or not they have diabetes, according to the UK Kidney Association’s updated guidelines (2023). According to current guidance an SGLT2i may be appropriate for you if your eGFR is over 20ml/min and you have albuminuria (urine ACR is over 25mg/mmol), or indeed even with less albuminuria if your kidney function is deteriorating.

Safety and Tolerability
SGLT2 inhibitors are generally safe and well-tolerated. Most people experience no or mild side effects. However, it's essential to be aware of potential side effects, including:

Urinary Tract Infections (UTIs):  
While uncommon, UTIs may occur. If you experience symptoms like pain, burning, frequent urination, or fever, contact your healthcare provider. In most cases, you can continue taking your SGLT2 inhibitor if the UTI is mild, but consult a pharmacist, nurse or your doctor.

Thrush (Candida Infection):
If you notice symptoms such as oral or genital discomfort, white patches, or itching, seek medical attention as for a UTI. You may be able to continue your medication for mild cases, but severe cases may require temporary discontinuation.

Do not start an SGLT2 inhibitor if you currently have a urinary tract infection, thrush or sore or broken skin in the groin or perineum area. Seek medical advice (as above) and wait until the skin is intact and recovered before commencing the medication. 

An SGLT2i may not be appropriate for you if you have Adult Polycystic Kidney Disease.

Sick Day Rules
In certain situations, it's essential to follow "sick day rules" to maintain your safety:

- Risk of Severe Dehydration:
If you experience vomiting, diarrhoea, or are unable to eat or drink due to illness, stop taking your SGLT2 inhibitor until you are fully recovered.

- Hospitalization or Surgery:
If you are admitted to the hospital or require surgery, inform your healthcare providers that you are taking an SGLT2 inhibitor. Your healthcare team will determine the best course of action during these periods.

Important Reminders
Always take your medication as prescribed by your healthcare provider. Attend your regular check-ups and follow-up appointments to monitor your kidney function and overall health. Maintain good hygiene to reduce the risk of infections. Keep a list of your current medications and share it with all your healthcare providers.

Conclusion
SGLT2 inhibitors, like Dapagliflozin, can be valuable in managing your chronic kidney disease. They have the potential to slow down the progression of your condition and improve your overall well-being. Please consult your healthcare provider if you have any concerns or experience any side effects, and always follow their recommendations. 

Remember, this blog serves as a general guide. Your healthcare provider will provide personalized advice based on your unique situation. 

For the most up-to-date and specific information about your SGLT2 inhibitor please consult your healthcare provider. 

Disclaimer: This leaflet does not replace professional medical advice. Always consult your healthcare provider regarding your specific medical condition and treatment plan.

Understanding the link between high cholesterol and kidney disease

It has been known for a very long time that people with chronic kidney disease (CKD) have a very much higher than normal incidence of cardiovascular disease, such as strokes and heart attacks. We’ve asked consultant nephrologist Dr Christopher Lawrence to explain just when the link between high cholesterol and renal disease was first discovered and how the conditions relate to one another.

Please click to download the full article
- Full article here
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One particular subset Protein in your urine: could it be glomerulonephritis?

Glomerulonephritis is an umbrella term for a group of kidney diseases that affect the blood vessels in your kidney. Glomerulonephritis can cause significant damage to your kidneys if left untreated. The problem is that the symptoms can be nebulous – and diagnosis is difficult. We spoke to leading consultant nephrologist Dr Christopher Lawrence about what symptoms patients should watch out for, and what the doctor will do if they suspect glomerulonephritis.

Please click to download the following fact sheets
- Could it be glomerulonephritis?
- Understanding your diagnosis
- Treating glomerulonephritis
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Help! My doctor says I have Chronic Kidney Disease!

Being given a label, or a diagnosis, of Chronic Kidney Disease (CKD) can be bewildering and frightening at the same time.  
The immediate instinct is to assume the worst and browsing the internet often stokes these fears. Few medical professionals are well versed in kidney problems, for some reason the subject instils fear in non-specialist healthcare professionals and members of the public alike. Traditionally the subject is neglected at medical school and for many doctors remains shrouded in mystique and mystery throughout their careers. In reality the subject is straight forward, logical and follows some basic rules. Kidney doctors don't help themselves. ‘Chronic Kidney Disease’ is in some ways a terrible piece of terminology. It isn't a ‘disease’ at all in fact. It isn't catching (usually!); it doesn't have a single cause; and there isn't a straightforward 'treatment' for it. Chronic Kidney Disease is simply a description of the level of a person's kidney function. A label of Chronic Kidney Disease can be of no significance whatsoever (except perhaps to cause alarm, and put the price of travel insurance up); or conversely it can be of the greatest significance and result in genuinely life changing events.

I set out to demystify the terms doctors use, and the hospital processes that patients experience, when 'diagnosed' with chronic kidney disease. Hopefully this will allow a person with a label of 'Chronic Kidney Disease' to understand their situation; to become an expert patient; to be reassured where reassurance is appropriate and to be empowered and facilitated where reassurance would not be appropriate.