Table 12.

Mitigation of Side Effects for Newer Agents to Treat Diabetic Kidney Disease

Side effects	Mitigation strategies
SGLT2 inhibitors
Genital mycotic infections Volume depletion	○ Hygiene, topical antifungals ○ Proactive dose reduction of diuretics in persons at risk for hypovolemia ○ Hold SGLT2is during GI illness (nausea, vomiting, diarrhea) ○ Improve glucose control to reduce glucosuria
Ketoacidosis	○ Educate persons with DM on early recognition ○ “STOP DKA” protocol (stop SGLT2i, test for ketones, maintain fluid and carbohydrate intake, use maintenance and supplemental insulin)
Hypoglycemia	○ Adjustment of background antihyperglycemic agents
GLP-1 receptor agonists
Nausea/vomiting/diarrhea	○ Patient education on tolerability and symptom recognition ○ Start at lowest dose and titrate slowly
Hypoglycemia	○ Adjustment of background antihyperglycemic agents
Finerenone
Hyperkalemia	○ Dietary restriction of potassium ○ Thiazide or loop diuretics ○ SGLT2i ○ Potassium-binding agents (patiromer or sodium zirconium cyclosilicate)

Abbreviations: DM = diabetes mellitus; GI = gastrointestinal; GLP-1 = glucagon-like peptide 1; SGLT2i = sodium-glucose cotransporter 2 inhibitor