From the Guidelines
Yes, you should hold Farxiga with AKI, as the medication's efficacy and safety depend on proper kidney function, and its use in patients with acute kidney injury may lead to worsening kidney function or other complications. When considering the management of patients with acute kidney injury (AKI) who are taking Farxiga (dapagliflozin), a sodium-glucose cotransporter 2 (SGLT2) inhibitor, it is crucial to prioritize the potential risks associated with continued use of the medication in the context of impaired kidney function. According to the study published in the Mayo Clinic Proceedings in 2022 1, SGLT2 inhibitors, including dapagliflozin, have a recommended kidney dose adjustment, emphasizing that they are not recommended for glucose lowering in patients with certain levels of kidney impairment. Key points to consider include:
- The glucose-lowering effect of SGLT2 inhibitors is blunted with reduced kidney function, suggesting that their efficacy may be diminished in the setting of AKI.
- The medication's mechanism of action, which involves increasing the excretion of glucose in the urine, relies on adequate kidney function, and its use in AKI could potentially exacerbate kidney injury or lead to volume depletion and electrolyte imbalances.
- The study provides specific guidance on the use of dapagliflozin in patients with chronic kidney disease (CKD) but does not directly address AKI; however, the principles of avoiding further kidney injury and ensuring the safe use of medications in the context of impaired kidney function apply. Given these considerations, the most prudent approach is to temporarily discontinue Farxiga in patients who develop AKI, with the decision to restart the medication being made on an individual basis once kidney function has recovered or stabilized, under the guidance of a healthcare provider.
From the FDA Drug Label
Withhold DAPAGLIFLOZIN TABLETS, if possible, in temporary clinical situations that could predispose patients to ketoacidosis. Dapagliflozin can cause intravascular volume depletion which may sometimes manifest as symptomatic hypotension or acute transient changes in creatinine. There have been post-marketing reports of acute kidney injury, some requiring hospitalization and dialysis, in patients with type 2 diabetes mellitus receiving SGLT2 inhibitors, including dapagliflozin.
Hold Farxiga with AKI: Yes, it is recommended to withhold DAPAGLIFLOZIN TABLETS in temporary clinical situations that could predispose patients to ketoacidosis, such as acute kidney injury (AKI). Patients with impaired renal function, including those with AKI, may be at increased risk for volume depletion or hypotension. 2 2
From the Research
Holding Farxiga with Acute Kidney Injury (AKI)
- The decision to hold Farxiga (dapagliflozin) in patients with AKI depends on various factors, including the severity of AKI, the underlying cause, and the patient's overall clinical condition 3.
- According to the study on acute kidney injury diagnosis and management, general management principles for AKI include discontinuation of nephrotoxic medications and adjustment of prescribed drugs according to renal function 3.
- However, studies on the use of dapagliflozin in patients with acute decompensated heart failure suggest that it may not be necessary to hold the medication in patients with AKI, as it has been shown to improve body weight loss and reduce the need for loop diuretics without causing significant impairment of renal function 4.
- Another study found that dapagliflozin use was associated with a lower risk of post-contrast AKI in patients with type 2 diabetes and chronic kidney disease undergoing an elective coronary procedure 5.
- Additionally, a study on the association of SGLT2 inhibitor dapagliflozin with risks of AKI and all-cause mortality in acute myocardial infarction patients found that dapagliflozin was associated with lower risks of incident AKI and all-cause mortality 6.
- It is essential to consider the individual patient's circumstances and consult with a healthcare professional to determine the best course of action regarding holding Farxiga with AKI 7.