From the Guidelines
Jardiance (empagliflozin) should be continued as long as it is well tolerated and kidney replacement therapy is not imminent, even when the eGFR falls below 30 mL/min/1.73 m2. This recommendation is based on the latest evidence from the 2020 KDIGO clinical practice guideline, as reported in the Annals of Internal Medicine 1. The key points to consider are:
- SGLT2 inhibitors, such as empagliflozin, may cause a modest reduction in eGFR that is hemodynamic in nature and reversible, which is not a reason to discontinue therapy.
- Long-term eGFR preservation has been reported with continuation of these agents.
- The medication can be continued as long as it is well tolerated and kidney replacement therapy is not imminent, even with an eGFR below 30 mL/min/1.73 m2.
- Regular monitoring of kidney function, glycemia, volume status, and experience of other adverse effects is essential.
- Patients experiencing acute kidney injury should temporarily discontinue Jardiance until the condition resolves. It's worth noting that the American College of Cardiology also provides guidance on the use of SGLT2 inhibitors, including empagliflozin, in patients with type 2 diabetes and cardiovascular disease or risk factors 1. However, the most recent and highest-quality evidence supports the continuation of empagliflozin in patients with impaired renal function, as long as it is well tolerated and kidney replacement therapy is not imminent.
From the FDA Drug Label
Use of JARDIANCE for glycemic control in patients without established cardiovascular disease or cardiovascular risk factors is not recommended when eGFR is less than 30 mL/min/1.73 m2. JARDIANCE is contraindicated in patients on dialysis [see Contraindications (4)]. There are insufficient data to support a dosing recommendation in patients with eGFR below 20 mL/min/1.73 m2.
The FDA drug label recommends discontinuing Jardiance (Empagliflozin) at an eGFR less than 30 mL/min/1.73 m2 for patients without established cardiovascular disease or cardiovascular risk factors, and it is contraindicated in patients on dialysis. Additionally, there are insufficient data to support a dosing recommendation in patients with eGFR below 20 mL/min/1.73 m2 2.
From the Research
Impaired Renal Function and Jardiance (Empagliflozin) Discontinuation
- The provided studies do not directly address the specific level of impaired renal function at which Jardiance (Empagliflozin) is discontinued 3, 4, 5, 6, 7.
- However, the studies suggest that empagliflozin can be beneficial for patients with type 2 diabetes and impaired renal function, as it has been shown to slow the progression of kidney disease and reduce the risk of clinically relevant renal events 5, 6, 7.
- The EMPA-REG OUTCOME trial, which is referenced in several of the studies, included patients with an estimated glomerular filtration rate (eGFR) of at least 30 ml per minute per 1.73 m(2) of body-surface area 5, 6, 7.
- The studies do not provide a specific eGFR threshold for discontinuing empagliflozin, but rather suggest that the medication can be beneficial for patients with impaired renal function, including those with an eGFR below 60 ml per minute per 1.73 m(2) 6.
- It is worth noting that the adverse-event profile of empagliflozin in patients with impaired kidney function at baseline was similar to that reported in the overall trial population 7.