Yes, discontinue Jardiance (empagliflozin) in patients on chronic dialysis.
Jardiance is contraindicated in patients on dialysis 1. The FDA drug label explicitly states this as an absolute contraindication, and this should guide your clinical decision-making above all else.
Why This Recommendation Exists
The mechanism of SGLT2 inhibitors like empagliflozin depends on functioning nephrons to increase urinary glucose excretion. In dialysis patients, there is insufficient residual kidney function for the drug to work as intended for glucose control. The FDA has determined that the risk-benefit profile does not support use in this population 1.
What the Guidelines Say About Continuation
The KDIGO 2022 guidelines provide nuanced guidance that stops short of dialysis. They state that once an SGLT2i is initiated, it is reasonable to continue even if eGFR falls below 20 mL/min/1.73 m², unless kidney replacement therapy is initiated 2. This is a critical distinction—the guideline explicitly identifies dialysis initiation as a stopping point.
The consensus statement reinforces that SGLT2i should be recommended for patients with eGFR ≥20 mL/min/1.73 m² and can be continued at lower levels of eGFR, but this guidance does not extend to dialysis 3.
The Evidence Gap
While there is emerging research examining empagliflozin safety in dialysis patients 4, this represents investigational use in clinical trials, not standard practice. A small 2025 study of 17 patients showed no significant adverse events with escalating doses, but this preliminary safety data does not override the FDA contraindication or established guidelines.
Clinical Algorithm for Decision-Making
If patient is already on dialysis:
- Discontinue Jardiance immediately
- Transition to alternative glucose-lowering agents appropriate for dialysis patients (insulin, DPP-4 inhibitors with dose adjustment)
- Monitor for volume status changes after discontinuation
If patient is approaching dialysis (eGFR <20 mL/min/1.73 m²) but not yet on dialysis:
- Continue Jardiance for cardiovascular and kidney protection benefits
- Discontinue when dialysis is initiated
- Do not restart after dialysis begins
Important Caveats
The FDA label notes post-marketing reports of acute kidney injury requiring dialysis in patients on SGLT2 inhibitors 1. While this refers to acute dialysis needs rather than chronic dialysis patients, it underscores the complex relationship between these medications and severe kidney dysfunction.
Volume depletion risks are heightened in patients with impaired renal function 1, and dialysis patients already face significant volume management challenges that would be complicated by continuing an SGLT2i.