From the Guidelines
Farxiga (dapagliflozin) is not recommended for patients on dialysis due to impaired renal function, as its glucose-lowering efficacy is minimal at eGFR <45 mL/min/1.73 m2 and lower, and it may not provide the intended benefits while potentially increasing the risk of adverse effects 1. The medication works by causing the kidneys to remove excess glucose through urine, but this mechanism becomes ineffective when kidney function is severely compromised, as in dialysis patients.
- Key points to consider:
- The glucose-lowering effect of Farxiga is reduced with decreased kidney function, and it is not recommended for glucose lowering in patients with eGFR <45 mL/min/1.73 m2 1.
- However, Farxiga may be continued in patients with heart failure or chronic kidney disease who are already on the medication, but initiation is not recommended in patients with eGFR <25 mL/min/1.73 m2 1.
- The FDA specifically contraindicates Farxiga in patients with eGFR less than 30 mL/min/1.73m², which includes dialysis patients. Using Farxiga in this situation would not provide the intended benefits and might potentially increase the risk of adverse effects.
- If you are on dialysis and need medication for diabetes or heart failure (conditions Farxiga treats), your healthcare provider should recommend alternative medications that are safe and effective for patients with end-stage renal disease, such as other SGLT2 inhibitors or GLP-1 receptor agonists that have been shown to have cardiovascular and kidney benefits in patients with chronic kidney disease 1.
From the FDA Drug Label
The impact of hemodialysis on dapagliflozin exposure is not known [see Warnings and Precautions (5.2), Use in Specific Populations (8. 6), and Clinical Studies (14)].
The FDA drug label does not answer the question.
From the Research
Dapagliflozin Use in Dialysis Patients
- Dapagliflozin, also known as Farxiga, is a sodium-glucose co-transporter-2 (SGLT2) inhibitor used to manage type 2 diabetes by reducing renal glucose reabsorption and increasing urinary glucose excretion 2.
- Initially, dapagliflozin was not recommended for patients with moderate or severe renal impairment 2.
- However, recent studies have shown that dapagliflozin can be beneficial for patients with chronic kidney disease (CKD), with or without type 2 diabetes, in reducing the risk of kidney disease progression, cardiovascular death, and hospitalization for heart failure 3, 4.
- A study published in 2023 investigated the pharmacokinetic properties of dapagliflozin in patients with kidney failure on dialysis and found that dapagliflozin was well-tolerated, slightly dialyzable, and had non-accumulating pharmacokinetic properties 5.
- Another study published in 2021 found that dapagliflozin reduced albuminuria in patients with CKD, with or without type 2 diabetes, which is associated with a lower risk of kidney failure 6.
Key Findings
- Dapagliflozin can be used in patients with CKD, with or without type 2 diabetes, to reduce the risk of kidney disease progression and cardiovascular events 3, 4.
- The drug is well-tolerated in patients with kidney failure on dialysis, with minimal dialyzability and no accumulation 5.
- Dapagliflozin reduces albuminuria in patients with CKD, which is associated with a lower risk of kidney failure 6.
- The use of dapagliflozin in patients on dialysis due to impaired renal function may be considered, but it is essential to consult with a healthcare professional to determine the best course of treatment 5.