To Hold or Not to Hold, That is the Question: Sick Day Medication Guidance as Routine Care

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Cardiovascular and kidney protective medications like SGLT2 inhibitors, RAAS inhibitors, and MRAs are increasingly used in combination.
• The mechanisms reducing blood pressure and glomerular hypertension can also compromise kidney perfusion during volume depletion, increasing AKI risk.
• Sick day medication guidance to mitigate AKI risk is not widely adopted by practitioners.

Purpose of the Study:

• To highlight the value of sick day medication guidance for patients using SGLT2 inhibitors, RAAS inhibitors, and MRAs.
• To demonstrate how this guidance can reduce AKI risk and associated costs.
• To promote more consistent use of these beneficial medications.

Main Methods:

• This is a Perspective article, not a primary research study.
• It analyzes the barriers to adoption of sick day medication guidance.
• It argues for the benefits of implementing such guidance.

Main Results:

• Barriers include confusion over sick day criteria, unclear holding/resuming instructions, patient hesitancy, lack of benefit data, and concerns about therapeutic interruption.
• Sick day guidance can be a valuable counseling tool for patients.
• Implementing guidance can reduce AKI episodes and costs.

Conclusions:

• Sick day medication guidance is a valuable tool for managing SGLT2 inhibitors, RAAS inhibitors, and MRAs.
• It can mitigate the risk of acute kidney injury (AKI) and associated healthcare costs.
• Proper guidance promotes consistent patient adherence and maximizes therapeutic benefits.