SGLT2 Inhibition and Kidney Potassium Homeostasis : Clinical Journal of the American Society of Nephrology
s either cause no effect or a slight reduction in plasma K+ concentration in patients with normal kidney function but seem to exert a protective effect against hyperkalemia in the setting of reduced kidney function or when given with drugs that block the renin-angiotensin-aldosterone axis. In this review, we discuss the changes in kidney physiology after the administration of SGLT2 inhibitors predicted to cause both hypokalemia and hyperkalemia. We conclude that these factors offset one another, explaining the uncommon occurrence of dyskalemias with these drugs. Careful human studies focusing on the determinants of kidney K+ handling are needed to fully understand how these drugs attenuate the risk of hyperkalemia and yet rarely cause hypokalemia….