Effects of Jardiance (Empagliflozin) on Creatinine and Potassium Levels
Jardiance (empagliflozin) does not typically increase creatinine or potassium levels and may actually reduce the risk of hyperkalemia in patients with chronic kidney disease and type 2 diabetes. 1
Creatinine Effects
Empagliflozin's effects on serum creatinine differ from other medications that affect the renin-angiotensin system:
- Unlike ACE inhibitors or ARBs, which can cause acute increases in serum creatinine (up to 30%) 2, empagliflozin does not typically cause significant creatinine elevations
- The FDA label for Jardiance notes that it may cause intravascular volume contraction that could potentially affect renal function, but this is different from direct effects on creatinine 3
- Monitoring recommendations:
- Evaluate renal function prior to initiating Jardiance
- Monitor periodically thereafter, with more frequent monitoring in patients with eGFR below 60 mL/min/1.73 m² 3
Potassium Effects
Evidence suggests empagliflozin may actually have beneficial effects on potassium levels:
- In a pooled analysis of clinical trials, empagliflozin was associated with a notably lower risk of hyperkalemia compared to placebo in patients with chronic kidney disease (hazard ratio 0.59,95% CI 0.37-0.96) 1
- Similar findings were observed with canagliflozin, another SGLT2 inhibitor, which reduced the incidence of hyperkalemia in patients with type 2 diabetes and CKD 4
Risk Factors and Monitoring
Certain clinical situations may increase risk of kidney function changes with Jardiance:
Factors that may predispose to acute kidney injury while on empagliflozin:
- Hypovolemia
- Chronic renal insufficiency
- Congestive heart failure
- Concomitant medications (diuretics, ACE inhibitors, ARBs, NSAIDs) 3
Temporary discontinuation of Jardiance is recommended in settings of:
- Reduced oral intake (acute illness or fasting)
- Fluid losses (gastrointestinal illness or excessive heat exposure) 3
Clinical Implications
Monitoring recommendations:
- Check baseline renal function before starting Jardiance
- Monitor periodically thereafter, with more frequent monitoring in patients with reduced eGFR
- Pay special attention during situations that may cause volume depletion
Precautions:
- Jardiance is not recommended when eGFR is persistently less than 45 mL/min/1.73 m²
- It is contraindicated in patients with eGFR less than 30 mL/min/1.73 m² 3
Combination therapy considerations:
- When used in combination with ACE inhibitors or ARBs, the risk of hyperkalemia may actually be lower than with ACE inhibitors or ARBs alone 1, 4
- Recent evidence suggests that combination therapy with finerenone (a mineralocorticoid receptor antagonist) and empagliflozin did not lead to unexpected adverse events related to hyperkalemia 5
In contrast to concerns about potassium and creatinine elevations with Jardiance, the evidence suggests that empagliflozin may have renal protective effects and may actually reduce the risk of hyperkalemia in patients with type 2 diabetes and CKD.