Sick day rules – AKI prevention in CKD patients
If CKD patients become sick and dehydrated (usually secondary to an infection, e.g. urine, chest or gastrointestinal), they should be advised to withhold the 7 groups of medications below.
This is because these drugs can precipitate AKI during such illnesses. And if they can be stopped in good time, this may prevent an AKI (rapid onset kidney failure) episode. At worse, AKI in this situation, can cause temporary or permanent dialysis.
This is especially true if the patient is vomiting or has diarrhoea (unless minor), or fevers, sweats and shakes – and are unable to maintain adequate fluid intake.
How should the rules be applied to you?
So. If you have CKD, and are unwell with such an infection for longer than 48 hours, stop these drugs and contact your doctor on that day – to make sure they agree with your action.
- SGLT2 inhibitors, e.g. Dapagliflozin – a diabetes, blood pressure and CKD tablet
- Sulphonylureas, e.g. Gliclazide – diabetes
- Angiotensin-converting enzyme inhibitors (ACEi), e.g. Ramipril – blood pressure
- Diuretics, e.g. Furosemide, Bumetanide, Bendroflumethazide, Spironolactone – water tablets
- Metformin – diabetes
- Angiotensin receptor blockers (ARBs), e.g. Losartan – blood pressure
- Non-steroidal anti-inflammatory drugs (NSAIDs), e.g. high dose Aspirin, Ibuprofen, Naproxen, Diclofenac – painkillers.
Note. If your blood pressure is low, your doctor may also ask you to stop other blood pressure tablets.
‘SSADMAN’ mnemonic
This is a way of remembering which drugs need to be stopped.
- S – SGLT2i
- S – Sulphonylureas
- A – ACEis
- D – Diuretics
- M – Metformin
- A – ARBs
- N – NSAIDs.
Restarting drugs that have been stopped
After discussion with your doctor, you should restart these drugs. This will usually be 24-48 hours after you are feeling better, and are eating and drinking normally.
‘Salford sick day rule’ cards
When the sick day rule concept was first devised by a hospital in Manchester (Salford), cards like this were produced for their patients.
Summary
We have described sick day rules, and how they lead to AKI prevention in CKD patients. We hope it has been helpful.
Last Reviewed on 23 April 2024