Effects of SGLT2 Inhibitors on Electrolytes in Patients with CKD: A Scoping Review

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have pleiotropic effects and are approved for use in heart failure and CKD apart from Diabetes Mellitus. Because SGLT2i block sodium-glucose reabsorption in the proximal tubule, their influence on electrolyte balance is particularly relevant. While data exist regarding their impact on electrolytes in diabetic populations, evidence is lacking in CKD patients. This scoping review aims to evaluate the effects of SGLT2i on electrolytes in patients with CKD Methods: We searched PubMed for articles published between 2015 and 2025 using the keywords “CKD,” “SGLT2 inhibitors,” and “electrolytes.” Inclusion criteria were clinical studies involving CKD patients treated with SGLT2 inhibitors, reporting electrolyte outcomes. Exclusion criteria included meta-analyses and literature reviews. Of 625 records screened, 8 studies met the inclusion criteria. Data were extracted on study design, population, SGLT2i type, CKD stage, and electrolyte outcomes. Results: The most commonly used SGLT2i were empagliflozin, dapagliflozin, and canagliflozin, mostly in patients with CKD stages 2–4. Some trials showed a mild decrease in serum sodium, while others didn’t find any significant changes in 24-hour urine sodium. Interestingly, a case report did report hypernatremia. The incidence of hyperkalemia and use of potassium binders was lower in patients on SGLT2i. There was also a mild rise in serum magnesium levels. Some studies showed increased calcium, and phosphate, along with FGF23 and PTH levels. Conclusion: SGLT2 inhibitors exert a modest influence on electrolyte profiles in CKD, with the most consistent findings involving phosphate. Although these changes appear clinically mild, their potential implications in combination with other agents such as RAAS inhibitors or immunosuppressants (e.g., tacrolimus in transplant recipients) require further research. Additional studies are needed to assess their electrolyte effects in advanced CKD, particularly stage 5 and dialysis-dependent patients.