Why Farxiga (Dapagliflozin) is Prescribed for Chronic Kidney Disease
Farxiga (dapagliflozin) is prescribed for patients with chronic kidney disease because it significantly reduces the risk of kidney disease progression, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure, with benefits seen regardless of whether patients have diabetes. 1
Evidence Supporting Dapagliflozin in CKD
Primary Benefits in CKD
- Dapagliflozin is FDA-approved specifically "to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression" 1
- In the landmark DAPA-CKD trial, dapagliflozin reduced the primary composite outcome (≥50% sustained decline in eGFR, end-stage kidney disease, or cardiovascular/renal death) by 39% compared to placebo (HR 0.61 [95% CI 0.51–0.72]; P < 0.001) 2
- The kidney-specific composite outcome (sustained decline in eGFR of ≥50%, ESKD, or death from renal causes) was reduced by 44% (HR 0.56 [95% CI 0.45–0.68]; P < 0.001) 2
Cardiovascular Benefits
- Dapagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure by 29% (HR 0.71 [95% CI 0.55–0.92]; P = 0.009) 2
- All-cause mortality was significantly decreased in patients taking dapagliflozin compared to placebo (P < 0.004) 2
Benefits Across Patient Populations
- The benefits of dapagliflozin extend to both patients with and without type 2 diabetes 3
- In DAPA-CKD, 67.5% of participants had type 2 diabetes, while the remaining one-third had CKD without diabetes 2
- Efficacy was consistent regardless of the underlying cause of CKD (diabetic nephropathy, glomerulonephritides, ischemic/hypertensive CKD, or other causes) 3
- Benefits were observed across all age groups, including older adults, and in both men and women 4
Dosing and Patient Selection
- For CKD patients, the recommended dose is 10 mg orally once daily 1
- Dapagliflozin can be used in patients with eGFR as low as 20 mL/min/1.73 m² 2
- The DAPA-CKD trial included patients with eGFR 25-75 mL/min/1.73 m² and urinary albumin-to-creatinine ratio (UACR) 200-5,000 mg/g 2
- Dapagliflozin is not recommended for CKD treatment in patients with polycystic kidney disease or those requiring or with recent history of immunosuppressive therapy for kidney disease 1
Long-Term Benefits
- Treatment with dapagliflozin may delay time to kidney failure by approximately 6.6 years compared to standard therapy 5
- The benefits are observed regardless of whether patients have established cardiovascular disease or not 6
- Dapagliflozin's renoprotective effects appear to be independent of its glucose-lowering properties, making it effective even in non-diabetic CKD 3, 7
Potential Side Effects and Monitoring
- Prior to initiating dapagliflozin, renal function and volume status should be assessed 1
- Common side effects include increased urination and genitourinary infections 2
- Volume depletion and ketoacidosis are potential risks but are generally outweighed by the significant renal and cardiovascular benefits 7
Clinical Implications
- Dapagliflozin represents a paradigm shift in CKD management, offering protection beyond traditional renin-angiotensin system blockade 7
- The medication should be considered for CKD patients regardless of diabetes status, as it provides significant mortality and morbidity benefits 2, 3
- The robust evidence from DAPA-CKD and other trials has established SGLT2 inhibitors like dapagliflozin as a cornerstone of modern CKD treatment 7