Do you recommend SGLT2i use for patients with chronic kidney disease, diabetes mellitus, and polycystic kidney disease? 

While we cannot conscientiously recommend this YET, I do not think it is necessarily contraindicated. I would not use it in conjunction with tolvaptan, but I think the results of the UC Denver trial will be informative. It may indeed be as useful for PKD patients as in other CKD patients, including for weight loss, but unfortunately, PKD patients were excluded from previous trials.

NCT05510115

Of course, more data is needed, but from the start, I would hold off for now, and would try other evidence-based interventions first (i.e., diet, strength training, anti-diabetics like metformin). Personally, I believe SGLT2i may be used along with GLP-1, however, we should wait for data to help us here. The issue with SGLT2i is the diuretic effect that may be exacerbated with the use of Tolvaptan and its polyuria effect.

The cornerstone of PKD treatment currently is to lower ADH levels. Given diuretic effects of SGLT2 inhibitors you risk increasing ADH levels leading to cyst progression. I personally recommend to avoid them in my ADPKD patients. The other issue is patients often are already dealing with polyuria from high fluid intake targets. If I were to consider using it in a patient with ADPKD (? HFrEF patient) would consider following urine osmolality levels trying to keep below 280. Would be interested to see if future trials show a benefit in this population.