Empagliflozin (Jardiance) Use in CKD Stage III
Yes, Jardiance (empagliflozin) is not only safe but recommended for patients with Chronic Kidney Disease (CKD) stage III, as it slows CKD progression and reduces cardiovascular events in patients with eGFR as low as 20 mL/min/1.73 m².
Efficacy in CKD Stage III
Empagliflozin has demonstrated significant benefits in patients with CKD stage III (eGFR 30-59 mL/min/1.73 m²):
The 2023 American Diabetes Association (ADA) guidelines specifically recommend SGLT2 inhibitors for people with stage 3 CKD or higher and type 2 diabetes, as they slow CKD progression and reduce heart failure risk independent of glucose management 1.
The EMPA-REG OUTCOME trial showed that empagliflozin reduced the risk of incident or worsening nephropathy by 39% and the risk of doubling of serum creatinine accompanied by eGFR ≤45 mL/min/1.73 m² by 44% 1, 2.
In patients with prevalent kidney disease at baseline, empagliflozin reduced the risk of cardiovascular death by 29%, all-cause mortality by 24%, and hospitalization for heart failure by 39% 3.
Dosing and Administration in CKD Stage III
Empagliflozin can be initiated at 10 mg daily in patients with eGFR ≥20 mL/min/1.73 m² 4, 5.
The drug can be continued as long as it is tolerated, even if eGFR falls below 20 mL/min/1.73 m², until renal replacement therapy is initiated 4.
No dose adjustment is required specifically for CKD stage III patients 5.
Monitoring Recommendations
When using empagliflozin in CKD stage III patients:
- Monitor renal function every 3-6 months 4
- Watch for signs of volume depletion, especially when combined with diuretics 4
- Be vigilant for genital mycotic infections, which are more common with SGLT2 inhibitors 4
- Regularly assess blood glucose levels, particularly when initiating treatment 4
Recent Evidence Supporting Use in CKD
The EMPA-KIDNEY trial, the most recent major study, demonstrated that empagliflozin:
- Reduced the risk of kidney disease progression or cardiovascular death in patients with CKD with eGFR as low as 20 mL/min/1.73 m² 6
- Slowed the rate of chronic eGFR decline by 50% compared to placebo 6
- Showed consistent benefits across different primary kidney diseases, including both diabetic and non-diabetic causes 6
Mechanism of Benefit in CKD
Empagliflozin provides renoprotection through multiple mechanisms:
- Reduces intraglomerular pressure 1
- Decreases albuminuria 1
- Reduces oxidative stress in the kidney by >50% 1
- Blunts increases in angiotensinogen 1
- Reduces NLRP3 inflammasome activity 1
Special Considerations
- Elderly patients (≥75 years) have an increased risk of volume depletion and urinary tract infections with empagliflozin 5
- The drug should be used with caution in patients at risk for volume depletion
- Empagliflozin is contraindicated in patients with eGFR <15 mL/min/1.73 m² or on dialysis 4
In conclusion, empagliflozin is not only appropriate but beneficial for patients with CKD stage III, with strong evidence supporting its use for both renal and cardiovascular protection in this population.