Can Farxiga (dapagliflozin) help patients with Chronic Kidney Disease (CKD)?

Farxiga (Dapagliflozin) for Chronic Kidney Disease

Farxiga (dapagliflozin) is strongly recommended for patients with chronic kidney disease (CKD) with eGFR ≥20 mL/min/1.73 m² as it significantly reduces the risk of kidney disease progression, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure. 1, 2

Efficacy in CKD

Dapagliflozin provides substantial benefits for CKD patients through several mechanisms:

• Kidney protection: Slows CKD progression independent of glucose-lowering effects 1
• Cardiovascular benefits: Reduces risk of heart failure hospitalization and cardiovascular death 1, 2
• Mortality reduction: Decreases all-cause mortality in CKD patients 3
• Albuminuria reduction: Decreases urinary albumin excretion by approximately 29.3% overall 4

Patient Selection Criteria

Dapagliflozin is indicated for CKD patients with:

• eGFR ≥20 mL/min/1.73 m² (previously limited to ≥25 mL/min/1.73 m²) 1
• With or without type 2 diabetes 2, 5
• With or without albuminuria, though benefits may be greater in those with higher levels of albuminuria 6

Important Considerations

• FDA approval: Specifically approved to reduce the risk of declining kidney function, kidney failure, cardiovascular death, and hospitalization for heart failure in adults with CKD 5
• Efficacy across age groups: Benefits observed across all age groups, including elderly patients (70+ years) 3
• Gender equality: Equally effective in both men and women 3

Clinical Practice Implementation

1. Initial assessment:

   • Measure baseline eGFR and urinary albumin-to-creatinine ratio (UACR)
   • Ensure eGFR ≥20 mL/min/1.73 m² before initiating therapy 1

2. Dosing:

   • Standard dose: 10 mg once daily 2
   • No dose adjustment needed for CKD until eGFR falls below 20 mL/min/1.73 m² 1

3. Monitoring:

   • Regular assessment of kidney function (eGFR)
   • Monitor for potential side effects (urinary tract infections, genital mycotic infections)
   • Watch for volume depletion, especially in elderly patients or those on diuretics 2

Combination Therapy

Dapagliflozin can be safely and effectively used with:

• Renin-angiotensin-aldosterone system (RAAS) inhibitors 7
• Calcium channel blockers 7
• Beta-blockers 7
• Diuretics (with caution regarding volume status) 7
• Antithrombotic and lipid-lowering agents 7

Potential Pitfalls and Cautions

• Contraindications: Avoid in patients with eGFR <20 mL/min/1.73 m² 1
• Ketoacidosis risk: Monitor for symptoms, especially during illness or reduced food intake 2
• Volume depletion: Elderly patients and those on diuretics are at higher risk 2
• Urinary tract infections: Increased risk, particularly in women 2
• Polycystic kidney disease: Not recommended for CKD treatment in patients with polycystic kidney disease or those on immunosuppressive therapy for kidney disease 2

Special Populations

• Elderly patients: Effective across all age groups, including septuagenarians and octogenarians 3
• Non-diabetic CKD: Beneficial effects extend to patients without diabetes, though albuminuria reduction may be less pronounced (-14.8% vs -35.1% in diabetic patients) 4
• Lower albuminuria patients: Real-world data suggests benefits may extend to patients with UACR <200 mg/g 6

Dapagliflozin represents a significant advancement in CKD management, offering kidney protection and cardiovascular benefits independent of glycemic effects, making it an essential component of modern CKD treatment.