Farxiga (Dapagliflozin) for CKD Stage 3b Patients
Farxiga 10mg once daily is strongly recommended for patients with CKD stage 3b as it significantly reduces the risk of kidney disease progression, cardiovascular events, and mortality, even at eGFR levels as low as 20 mL/min/1.73 m². 1
Efficacy in CKD Stage 3b
- Dapagliflozin 10mg daily is effective for patients with CKD stage 3b (eGFR 30-44 mL/min/1.73 m²) and can be initiated when eGFR is ≥25 mL/min/1.73 m² 1, 2
- The DAPA-CKD trial demonstrated significant benefits in patients with CKD regardless of diabetes status, with a 39% reduction in the primary composite outcome (sustained decline in eGFR ≥50%, end-stage kidney disease, or death from renal or cardiovascular causes) 3
- Dapagliflozin reduced the risk of kidney composite outcomes by 44% and cardiovascular death or hospitalization for heart failure by 29% in CKD patients 3, 1
- All-cause mortality was reduced by 31% in patients receiving dapagliflozin compared to placebo 3
Dosing and Administration
- For CKD patients, the recommended dose is 10mg once daily 2
- Dapagliflozin can be initiated in patients with eGFR ≥25 mL/min/1.73 m² 2
- If eGFR falls below 25 mL/min/1.73 m² during treatment, dapagliflozin may be continued at 10mg daily to maintain kidney and cardiovascular benefits 2
- No dose adjustment is required for patients with CKD stage 3b 1, 2
Benefits Beyond Glycemic Control
- While glucose-lowering efficacy is reduced at lower eGFR levels, kidney and cardiovascular benefits are preserved regardless of baseline eGFR 1
- Dapagliflozin reduces the risk of:
Real-World Evidence
- Real-world data from 93 Italian renal clinics showed that dapagliflozin reduced albuminuria by 25.1% in CKD patients, with 48.3% of patients achieving ≥30% albuminuria reduction 5
- Adverse events leading to drug discontinuation were rare (2%), with good safety profile in nephrology patients 5
Safety Considerations
- Dapagliflozin has a favorable safety profile in CKD patients 3, 5
- The most common adverse events include:
- Dapagliflozin can be safely used in combination with other cardiovascular medications without increasing serious adverse events 6
Important Clinical Considerations
- Assess renal function prior to initiation and periodically thereafter 2
- Evaluate volume status before starting treatment; correct volume depletion if present 2
- Temporarily withhold dapagliflozin at least 3 days before major surgery or procedures requiring prolonged fasting 2
- Monitor for signs of diabetic ketoacidosis in patients with diabetes 2
Comparison with Other Treatment Options
- SGLT2 inhibitors like dapagliflozin are preferred first-line agents for CKD patients, along with metformin in those with type 2 diabetes 1
- For patients requiring additional glucose control, GLP-1 receptor agonists are preferred as add-on therapy 1
- The benefits of dapagliflozin are consistent across all KDIGO risk categories, indicating efficacy across the spectrum of kidney disease severity 4
In conclusion, Farxiga (dapagliflozin) 10mg daily is highly effective for CKD stage 3b patients, providing significant kidney and cardiovascular protection regardless of diabetes status. Its benefits extend beyond glycemic control, making it a cornerstone therapy for CKD management.