Effect of sodium-glucose cotransporter-2 inhibitors on renal handling of electrolytes

Postgrad Med J. 2021 Dec;97(1154):819-824. doi: 10.1136/postgradmedj-2020-139348. Epub 2021 Feb 9.


Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are the latest introduction into the armamentarium of diabetes care in the present decade. By virtue of their beneficial effects, such as blood pressure-lowering, bodyweight reduction and significant renal and cardioprotective effects which extends beyond their glycaemic control effects, SGLT2i have become one of the most preferred oral antihyperglycaemic agents of recent times. However, they can influence tubular handling of electrolytes that can result in some electrolyte disturbances such as alteration in the serum levels of magnesium, potassium and phosphate levels. Some of these changes are mild or transient and may not have significant clinical implications. The underlying putative mechanism(s) responsible for disturbances of electrolytes are yet to be deciphered. In this review, we aim to describe electrolytes and acid-base abnormalities due to SGLT2i as well as to elucidate the underlying mechanism.

Keywords: adult nephrology; clinical physiology; diabetes & endocrinology; nephrology; physiology.

Publication types

  • Review

MeSH terms

  • Diabetes Mellitus, Type 2* / drug therapy
  • Diabetes Mellitus, Type 2* / metabolism
  • Diabetic Nephropathies* / drug therapy
  • Diabetic Nephropathies* / metabolism
  • Electrolytes
  • Glucose / metabolism*
  • Humans
  • Hypoglycemic Agents / pharmacology
  • Renal Elimination / drug effects
  • Renal Reabsorption / drug effects
  • Sodium
  • Sodium-Glucose Transporter 2 Inhibitors / pharmacology*
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use


  • Electrolytes
  • Hypoglycemic Agents
  • Sodium-Glucose Transporter 2 Inhibitors
  • Sodium
  • Glucose