SGLT2 Inhibitor Dosing in CKD: What You Need to Know

When managing SGLT2 inhibitors, a class of oral diabetes medications that also protect the kidneys by blocking glucose reabsorption in the kidneys. Also known as gliflozins, these drugs don’t just lower blood sugar—they slow kidney decline in people with chronic kidney disease, a long-term condition where kidneys lose their ability to filter waste and excess fluid. That’s why doctors now prescribe them for kidney protection, even in patients without diabetes.

Getting the dose right in chronic kidney disease, a long-term condition where kidneys lose their ability to filter waste and excess fluid isn’t one-size-fits-all. For example, dapagliflozin can be used down to an eGFR of 25 mL/min, while empagliflozin is approved as low as 20 mL/min. Canagliflozin, however, isn’t recommended if your eGFR drops below 30. These aren’t arbitrary numbers—they’re based on how the kidneys handle the drug. If your kidneys are too weak, the drug won’t work as intended, and you might get side effects like dehydration or low blood pressure. That’s why your doctor checks your eGFR before starting and repeats it every few months.

Side effects matter just as much as dosing. People on SGLT2 inhibitors can get yeast infections, especially women, or rare but serious issues like Fournier’s gangrene. Dehydration is common, especially if you’re also on diuretics. That’s why drinking enough water isn’t optional—it’s part of the treatment. And while these drugs help protect the heart and kidneys, they don’t fix everything. You still need to control blood pressure, cut back on salt, and avoid NSAIDs like ibuprofen, which can hurt your kidneys even more.

What you’ll find below are real-world guides that break down how these drugs work in people with kidney disease, what doses are safe, how to spot trouble early, and what alternatives exist if SGLT2 inhibitors aren’t right for you. No theory. No fluff. Just what works—and what to watch out for.