Why are SGLT-2 inhibitors used cautiously in clients with renal failure?

A. They are contraindicated in clients undergoing dialysis: SGLT-2 inhibitors depend on adequate kidney function to promote glucose excretion in the urine. In renal failure or during dialysis, they are ineffective and may increase risks of adverse effects. B. They increase the risk of hepatic dysfunction: SGLT-2 inhibitors are not strongly associated with hepatotoxicity. While rare liver enzyme elevations can occur, hepatic dysfunction is not the main concern in clients with renal failure. C. They cause severe hypoglycemia: SGLT-2 inhibitors generally have a low risk of causing hypoglycemia when used alone. Hypoglycemia is more likely when combined with insulin or sulfonylureas, but it is not the primary reason for cautious use in renal failure. D. They decrease the effectiveness of oral contraceptives: These medications do not alter the metabolism or absorption of oral contraceptives. There is no clinically significant interaction between SGLT-2 inhibitors and hormonal birth control methods.