Should Jardiance (Empboardibin) be held during Acute Kidney Injury (AKI)?

From the Guidelines

Jardiance (empardibin) should typically be temporarily discontinued during acute kidney injury (AKI). When a patient develops AKI, holding Jardiance is recommended until kidney function returns to baseline or stabilizes. This medication belongs to the SGLT2 inhibitor class, which works by preventing glucose reabsorption in the kidneys, leading to increased glucose excretion in urine. During AKI, the kidneys' ability to filter blood is compromised, and continuing Jardiance could potentially worsen kidney function or lead to complications like volume depletion, electrolyte abnormalities, or metabolic acidosis. Additionally, the medication's effectiveness is reduced when kidney function is significantly impaired.

The most recent and highest quality study, published in 2024 1, provides a strong recommendation for the use of SGLT-2 inhibitors, including empagliflozin, in individuals with chronic kidney disease, but does not specifically address the management of these medications during AKI. However, the study that is most relevant to the question of AKI management is the one from 2023 1, which discusses the risk of AKI with SGLT2 inhibitors and notes that they do not increase the risk of AKI. Nevertheless, the general principle of holding medications that may worsen kidney function during AKI is a prudent approach.

Key considerations for managing Jardiance during AKI include:

• Monitoring kidney function closely
• Assessing the risk of volume depletion and electrolyte abnormalities
• Evaluating the effectiveness of the medication in the context of impaired kidney function
• Consulting with a healthcare provider before making any changes to medication management

Once the AKI has resolved and kidney function has recovered, Jardiance can usually be restarted after reassessment by a healthcare provider. Patients should always consult with their healthcare provider about specific medication management during episodes of AKI rather than making decisions independently. The evidence from studies such as 1, 1, and 1 supports the use of SGLT2 inhibitors in patients with chronic kidney disease, but the specific scenario of AKI requires careful consideration of the potential risks and benefits.

From the FDA Drug Label

JARDIANCE causes intravascular volume contraction [see Warnings and Precautions (5. 1)] and can cause renal impairment [see Adverse Reactions (6. 1)]. There have been postmarketing reports of acute kidney injury, some requiring hospitalization and dialysis, in patients receiving SGLT2 inhibitors, including JARDIANCE; some reports involved patients younger than 65 years of age Before initiating JARDIANCE, consider factors that may predispose patients to acute kidney injury including hypovolemia, chronic renal insufficiency, congestive heart failure and concomitant medications (diuretics, ACE inhibitors, ARBs, NSAIDs) Consider temporarily discontinuing JARDIANCE in any setting of reduced oral intake (such as acute illness or fasting) or fluid losses (such as gastrointestinal illness or excessive heat exposure); monitor patients for signs and symptoms of acute kidney injury. If acute kidney injury occurs, discontinue JARDIANCE promptly and institute treatment

Yes, Jardiance (Empagliflozin) should be held during Acute Kidney Injury (AKI) as it can cause renal impairment and there have been postmarketing reports of acute kidney injury in patients receiving SGLT2 inhibitors, including JARDIANCE. The drug label recommends considering temporary discontinuation of JARDIANCE in settings of reduced oral intake or fluid losses and discontinuing promptly if acute kidney injury occurs 2.

From the Research

Acute Kidney Injury (AKI) and Jardiance (Empagliflozin)

• AKI is a common and severe complication in patients, especially those in the intensive care unit, with a significant impact on patient mortality and morbidity 3.
• The management of AKI involves general measures such as discontinuation of nephrotoxic agents and early hemodynamic stabilization 3.
• There is evidence to suggest that Sodium-glucose cotransporter 2 inhibitors (SGLT2i), such as empagliflozin, may be associated with an increased risk of AKI, particularly in patients with pre-existing kidney disease or those taking other nephrotoxic medications 4.
• The mechanisms by which AKI occurs under SGLT2i are not fully understood but may involve altered trans-glomerular filtration or kidney medullary hypoxia 4.

Management of AKI

• Measures to prevent AKI include optimization of volume status and avoidance of nephrotoxic medications 5.
• Crystalloids are preferred over colloids for most patients, and hydroxyethyl starches should be avoided 5.
• Volume overload in the setting of AKI is associated with adverse outcomes, so attention should be paid to overall fluid balance 5.
• Currently, there are no targeted pharmacotherapies approved for the treatment of AKI, and the optimal timing of renal replacement therapy in critically ill patients with AKI is unclear 5, 6.

Jardiance (Empagliflozin) and AKI

• Given the potential association between SGLT2i and AKI, it may be necessary to hold Jardiance (empagliflozin) during an episode of AKI, particularly if the patient is taking other nephrotoxic medications or has pre-existing kidney disease 4.
• However, the decision to hold Jardiance should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 4, 5.