From the Guidelines
Farxiga (dapagliflozin) can be initiated in patients with an estimated glomerular filtration rate (eGFR) of 25 mL/min/1.73m² or higher for both diabetes management and chronic kidney disease (CKD) prevention, as supported by the 2022 guideline recommendations 1. The recommended starting dose is 10 mg once daily, taken in the morning regardless of meals. For diabetes management, Farxiga can be continued until eGFR persistently falls below 25 mL/min/1.73m². For CKD prevention, the medication can be continued even if eGFR falls below 25 mL/min/1.73m², as it provides renal protection independent of its glucose-lowering effects.
Key considerations for initiating Farxiga include:
- Eligible patients: eGFR ≥20 ml/min per 1.73 m2, with high priority features including ACR ≥200 mg/g [≥20 mg/mmol] 2
- Potential contraindications: genital infection risk, diabetic ketoacidosis, foot ulcers, and immunosuppression 2
- Hypoglycemia risk: consider insulin/sulfonylurea dose reduction, especially in patients with insulin or sulfonylurea use, history of severe hypoglycemia, or HbA1c at or below goal 2
- Volume depletion risk: consider diuretic dose reduction, especially in patients with concurrent diuretic use, tenuous volume status, or history of AKI 2
The DAPA-CKD study demonstrated a significant benefit of dapagliflozin for the primary endpoint, with a hazard ratio of 0.61 (95% CI 0.51–0.72; P < 0.001) 1. This study supports the use of Farxiga in patients with CKD, including those with an eGFR of 25 mL/min/1.73m² or higher.
Patients should be monitored for potential side effects, including genital mycotic infections, urinary tract infections, and volume depletion, especially when initiating therapy. Adequate hydration should be maintained, and dose adjustments of concomitant medications like insulin or sulfonylureas may be needed to prevent hypoglycemia.
In summary, the initiation of Farxiga in patients with an eGFR of 25 mL/min/1.73m² or higher is supported by recent guidelines and studies, including the DAPA-CKD study and the 2022 guideline recommendations 1.
From the Research
Starting Glomerular Filtration Rate (GFR) for Initiating Farxiga (Dapagliflozin)
- The starting Glomerular Filtration Rate (GFR) for initiating Farxiga (Dapagliflozin) in patients with diabetes for the prevention of Chronic Kidney Disease (CKD) is an estimated glomerular filtration rate (eGFR) of 25 to 75 ml/min/1.73 m2 3, 4, 5
- Patients with an eGFR within this range and a urinary albumin/creatinine ratio of 200 to 5000 mg/g were included in the DAPA-CKD study 3, 4, 5
- The DAPA-CKD study demonstrated that dapagliflozin reduced the risk of kidney failure and heart failure in patients with CKD, including those with diabetic and non-diabetic CKD 3, 4
- The study also showed that the effects of dapagliflozin on kidney and cardiovascular outcomes were consistent across different glucose-lowering therapies and underlying causes of CKD 4, 6
Key Inclusion Criteria
- eGFR: 25 to 75 ml/min/1.73 m2 3, 4, 5
- Urinary albumin/creatinine ratio: 200 to 5000 mg/g 3, 4, 5
- Type 2 diabetes: 2906 (67.5%) patients had an initial diagnosis of type 2 diabetes 3
- Non-diabetic CKD: patients with CKD due to causes other than diabetes were also included 4, 5
Study Findings
- Dapagliflozin reduced the primary composite endpoint (time to eGFR reduction of 50% or more, time to end-stage renal disease, or renal or cardiovascular death) by 34% compared to placebo 3
- The relative risk reduction for the primary composite outcome with dapagliflozin was consistent in patients with type 2 diabetes (hazard ratio 0.64) and those without diabetes (hazard ratio 0.50) 4