Do you routinely discontinue SGLT2 inhibitors during febrile illness or acute infection in patients with diabetic kidney disease due to concern for volume depletion?

I would temporarily hold SGLT2 inhibitors during febrile illness or acute infection in patients with diabetic kidney disease if they are at risk of volume depletion (i.e. reduced oral intake, vomiting or diarrhea, high fevers with insensible fluid losses). Holding SGLT2 inhibitors in these acutely i...

Like RAASi (and diuretics), drug holidays during any significant vasodilatation or volume depletion illness, such as being febrile, or having vomiting, diarrhea, in which BP may become Angiotensin 2 dependent, while I don't tell my patients to hold the SGLT2i, I think it is NOT a bad idea. So no, bu...

Yes. Short term benefits of SGLT-2 are minimal but risk of worsening infection is there. I would hold them until infection is resolved.

Yes, I generally advise patients to hold while ill.

I do not. Indeed, SGLT2i have a modest diuretic effect, but I also don't routinely stop other diuretics, eg loop, thiazides or K sparing, in settings of fever or infection, either. That decision is individualized based on my assessment of volume status.