Can Farxiga (dapagliflozin) help improve kidney function in someone without diabetes?

Farxiga (Dapagliflozin) for Kidney Function in Non-Diabetic Patients

Yes, Farxiga (dapagliflozin) is beneficial for kidney function in people without diabetes, as it reduces the risk of kidney disease progression, end-stage kidney disease, and hospitalization for heart failure in adults with chronic kidney disease regardless of diabetes status. 1

Mechanism and Benefits for Non-Diabetic Kidney Disease

• Dapagliflozin works by inhibiting sodium-glucose co-transporter-2 (SGLT2) in the kidneys, which provides renoprotective effects independent of its glucose-lowering action 2
• The FDA has approved dapagliflozin to reduce the risk of declining kidney function, kidney failure, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease with or without type 2 diabetes 3
• Dapagliflozin's kidney benefits extend beyond glycemic control, making it effective even in patients without diabetes 2

Evidence Supporting Use in Non-Diabetic Kidney Disease

• The DAPA-CKD trial demonstrated that dapagliflozin improved outcomes in individuals with chronic kidney disease both with and without diabetes 2
• In patients with non-diabetic CKD, dapagliflozin treatment improved life expectancy by approximately 2 years and reduced the total incidence of kidney failure requiring kidney replacement therapy from 17.4% to 11.0% 4
• Dapagliflozin reduced the average years on kidney replacement therapy from 0.77 to 0.43 years in non-diabetic CKD patients 4

Clinical Considerations

• While a short-term (6-week) study showed dapagliflozin induced an acute and reversible decline in measured GFR in non-diabetic CKD patients, long-term outcomes demonstrate overall kidney protection 5
• Dapagliflozin can be used in patients with eGFR as low as 25 mL/min/1.73 m², though its glucose-lowering effects diminish at lower eGFR levels 2
• The medication is not recommended for use in patients with severe kidney impairment (eGFR <25 mL/min/1.73 m²) or on dialysis 1

Potential Side Effects and Monitoring

• Common side effects include genital mycotic infections and urinary tract infections 6, 7
• Dehydration can occur, especially in older adults or those taking diuretics, so adequate fluid intake should be maintained 1
• Monitor for ketoacidosis, which can occur even with normal blood glucose levels 1
• Regular assessment of kidney function is recommended, especially when initiating therapy 1

Cost-Effectiveness

• Adding dapagliflozin to standard care for non-diabetic CKD patients is cost-effective, with an incremental cost-effectiveness ratio of $60,000 per quality-adjusted life year gained 4
• The medication provides substantial clinical benefits that justify its cost, including reduced progression to kidney failure and less time on kidney replacement therapy 4

Practical Implementation

• Dapagliflozin is typically dosed at 10 mg once daily for kidney protection 1
• No dose adjustment is needed based on kidney function for the renoprotective indication, though the medication should not be used for glucose control in moderate to severe kidney disease 1
• Patients should be advised about the importance of maintaining adequate hydration while taking this medication 1

Dapagliflozin represents a significant advancement in kidney disease management, offering protection against disease progression in non-diabetic patients with chronic kidney disease, a population that previously had limited therapeutic options beyond renin-angiotensin system blockade.