Jardiance Should Be Discontinued with a Creatinine Clearance of 15
Yes, Jardiance (empagliflozin) should be discontinued in a patient with a creatinine clearance of 15 mL/min. 1
Rationale for Discontinuation
- According to the FDA label, Jardiance should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m² and should be discontinued if eGFR is persistently less than 45 mL/min/1.73 m² 1
- A creatinine clearance of 15 mL/min corresponds to CKD stage 5 (kidney failure), which is defined as GFR <15 mL/min/1.73 m², typically requiring consideration of renal replacement therapy 2
- SGLT2 inhibitors like empagliflozin are not expected to be effective for glycemic control in advanced CKD, as their mechanism of action depends on adequate renal filtration, which is severely compromised at this level of kidney function 2
Safety Concerns
- The efficacy and safety of Jardiance have not been established in patients with severe renal impairment, with end-stage renal disease (ESRD), or receiving dialysis 1
- At very low creatinine clearance levels, there is increased risk of adverse effects including reduced drug clearance potentially leading to drug accumulation and electrolyte abnormalities 2
- The glucose-lowering benefit of Jardiance decreases in patients with worsening renal function, while the risks of renal impairment, volume depletion adverse reactions, and urinary tract infection-related adverse reactions increase 1
Monitoring and Alternative Medications
- Assessment of renal function is recommended prior to initiation of Jardiance and periodically thereafter 1
- For patients with severe renal impairment requiring antidiabetic therapy, consider insulin (with dose adjustment), DPP-4 inhibitors with appropriate dose adjustments, or GLP-1 receptor agonists like liraglutide or dulaglutide which require no dose adjustment in severe renal impairment 2
- Similar to other medications that are affected by renal function, close monitoring of renal function and electrolytes is essential when managing patients with renal impairment 3
Common Pitfalls to Avoid
- Continuing SGLT2 inhibitors in severe renal impairment based on potential renoprotective effects without considering the safety risks 2
- Not recognizing that the glycemic efficacy of SGLT2 inhibitors is significantly reduced at low GFR levels, potentially leading to inadequate diabetes control 2
- Failing to reassess medication appropriateness when renal function declines below threshold values 1
By discontinuing Jardiance in a patient with a creatinine clearance of 15 mL/min, you are following evidence-based guidelines that prioritize patient safety and medication efficacy.