Would you initiate a SGLT2 inhibitor for a patient on chronic lithium with the goal of preserving kidney function?

A recent observational study suggested that SGLT2 inhibitor use is associated with a significant improvement in eGFR trajectories for patients on chronic lithium therapy, potentially reversing the decline associated with lithium-associated renal dysfunction. However, there are risks associated with ...

It would not be my first choice of treatment. After amiloride/ACE/ARB if there is significant proteinuria, I would consider it.

I would not be inclined to go to an SGLT-2 inhibitor in this situation. The nephrotoxicity of lithium is tubulointerstitial, not glomerular, primarily. I would not expect an SGLT-2 inhibitor to be nephroprotective and may have other adverse effects, given the other kidney effects of lithium. I do no...