Can Jardiance (Empagliflozin) be taken with impaired renal function, specifically a reduced estimated Glomerular Filtration Rate (eGFR)?

From the Guidelines

Jardiance (empagliflozin) can be taken with reduced eGFR, but with important limitations, as it should not be initiated in patients with eGFR below 30 mL/min/1.73m², and its use should be discontinued when eGFR falls persistently below 30 mL/min/1.73m², according to the most recent guidelines 1.

Key Considerations for Jardiance Use in Impaired Renal Function

• For patients with eGFR between 30-45 mL/min/1.73m², Jardiance can be continued if already taking it, but should not be newly initiated.
• For those with eGFR between 45-60 mL/min/1.73m², Jardiance can be both initiated and continued at the standard dosing.
• The reason for these restrictions is that Jardiance works by blocking glucose reabsorption in the kidneys, causing glucose excretion in urine, and with severely reduced kidney function, the medication becomes less effective and the risk of side effects may increase.

Monitoring and Patient Education

• Regular kidney function monitoring is essential while taking Jardiance, especially for those with already compromised kidney function.
• Patients should immediately inform their healthcare provider if they experience symptoms of kidney problems such as decreased urination or swelling in the legs or feet.

Evidence-Based Recommendations

• The American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) recommend considering SGLT2 inhibitors like empagliflozin for patients with type 2 diabetes and CKD, with careful consideration of eGFR and potential benefits and risks 1.
• The most recent guidelines emphasize the importance of individualized treatment decisions, taking into account patient factors, comorbidities, and eGFR 1.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

2.2 Patients with Renal Impairment Assessment of renal function is recommended prior to initiation of JARDIANCE and periodically thereafter. JARDIANCE should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m2. No dose adjustment is needed in patients with an eGFR greater than or equal to 45 mL/min/1. 73 m2. JARDIANCE should be discontinued if eGFR is persistently less than 45 mL/min/1.73 m2

Key Points:

• JARDIANCE should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m2.
• No dose adjustment is needed in patients with an eGFR greater than or equal to 45 mL/min/1.73 m2.
• JARDIANCE should be discontinued if eGFR is persistently less than 45 mL/min/1.73 m2. JARDIANCE can be taken with impaired renal function, but with certain restrictions, as outlined above 2.

From the Research

Jardiance (Empagliflozin) and Impaired Renal Function

• The use of Jardiance (Empagliflozin) in patients with impaired renal function, specifically a reduced estimated Glomerular Filtration Rate (eGFR), has been studied in various clinical trials 3, 4, 5, 6.
• According to the study published in the Journal of the American Society of Nephrology, empagliflozin slowed the progression of chronic kidney disease (CKD) in patients with type 2 diabetes and cardiovascular disease 4.
• The study found that empagliflozin was associated with a uniform shift in individual eGFR slopes across all periods, and the annual mean slope did not decline with empagliflozin during chronic treatment 4.
• Another study published in the same journal found that an acute reduction in eGFR upon treatment initiation with dapagliflozin, a similar SGLT2 inhibitor, was not associated with higher rates of CKD progression 5.
• The study published in CJC open found that the sodium-glucose cotransporter 2 inhibitors, including empagliflozin, are effective at reducing adverse cardiovascular and renal outcomes in patients with heart failure and CKD, with an eGFR ≥ 20 mL/min per 1.73 m2 3.
• However, it is essential to note that the use of empagliflozin in patients with impaired renal function should be carefully monitored, as the drug can cause a decline in kidney function due to its osmotic diuretic effect 3.

Dosage and Monitoring

• The dosage of empagliflozin in patients with impaired renal function should be carefully considered, and the patient's renal function should be monitored frequently 3.
• The study published in the Journal of the American Society of Nephrology found that the hemodynamic effects of empagliflozin, associated with reduction in intraglomerular pressure, may contribute to long-term preservation of kidney function 4.
• However, the presence of CKD in a patient should not preclude the use of empagliflozin, and the benefits and risks of the drug should be carefully weighed in each individual case 3.