Can we prescribe Farxiga (dapagliflozin) to a patient with mildly decreased kidney function, specifically an estimated Glomerular Filtration Rate (eGFR) of 79?

Can You Prescribe Farxiga at eGFR 79?

Yes, you can and should prescribe Farxiga (dapagliflozin) to a patient with an eGFR of 79 mL/min/1.73 m², as this level of kidney function is well above all safety thresholds and allows for full cardiovascular and renal protective benefits.

eGFR 79 is Stage 2 CKD - No Restrictions Apply

An eGFR of 79 mL/min/1.73 m² represents Stage 2 chronic kidney disease (slightly decreased GFR with kidney damage) 1. At this level of kidney function, dapagliflozin can be initiated without any dose modifications or special precautions 1.

Guideline-Based Dosing Recommendations

• No dose adjustment needed: The standard 10 mg daily dose of dapagliflozin is appropriate for eGFR ≥60 mL/min/1.73 m² 1
• Contraindications begin much lower: Dapagliflozin is only contraindicated when eGFR falls below 30 mL/min/1.73 m² or in patients with end-stage renal disease 1
• Glycemic control limitations: While not recommended for initiation for glycemic control when eGFR <45 mL/min/1.73 m², this restriction does not apply to cardiovascular or renal benefits, and your patient's eGFR of 79 is well above this threshold 1

Evidence Supporting Use at This eGFR Level

The landmark DAPA-CKD trial enrolled patients with eGFR as low as 25 mL/min/1.73 m² and demonstrated significant renal and cardiovascular benefits (hazard ratio 0.61 for the primary composite outcome) 2. Your patient with eGFR 79 falls well within the range where maximal benefit is expected.

Patients with baseline eGFR >60 mL/min/1.73 m² in the DAPA-HF trial showed consistent cardiovascular benefits (HR 0.77) with no safety concerns 3. The DERIVE study specifically examined patients with moderate renal impairment (eGFR 45-59) and confirmed efficacy and safety 4.

What to Monitor After Initiation

• Expect an initial eGFR dip: A transient decrease of 3-5 mL/min/1.73 m² within the first month is normal and hemodynamically mediated 1, 5
• This dip is not harmful: Among patients with heart failure, an initial eGFR decline >10% after dapagliflozin was not associated with subsequent cardiovascular or kidney events (adjusted HR 0.90) 5
• eGFR typically returns to baseline: Kidney function generally stabilizes or returns to baseline within weeks, followed by long-term nephroprotection 1, 4
• Check renal function at 2-4 weeks: Monitoring in the first several weeks is reasonable, particularly to reassure both clinician and patient 1

Key Clinical Pearls

• Do not discontinue for initial eGFR decline: Clinical guidance strongly supports continuing SGLT2 inhibitors despite initial eGFR drops 5, 6
• Benefits extend beyond glycemic control: Even if initiated for diabetes management, dapagliflozin provides cardiovascular and renal protection independent of glucose lowering 2, 3
• Long-term renal protection: Dapagliflozin slows the rate of eGFR decline over time (-1.09 vs -2.85 mL/min/1.73 m² per year with placebo, P<0.001) 3

Additional Safety Considerations at eGFR 79

At this level of kidney function, standard precautions apply 1:

• Volume status: Consider reducing diuretic dose if the patient is on aggressive diuresis, as dapagliflozin has natriuretic effects 1
• Hypoglycemia risk: If the patient is on insulin or sulfonylureas, reduce those doses (insulin by ~20%, sulfonylurea by 50%) to prevent hypoglycemia 1
• Genital mycotic infections: Counsel about this common side effect (occurs in ~5-10% of patients) 1
• Euglycemic DKA: Rare but important to discuss, especially in insulin-treated patients; advise stopping dapagliflozin 3 days before planned surgery 1

Bottom line: eGFR 79 is an ideal kidney function level for initiating dapagliflozin with full dosing and expected maximal benefit for cardiovascular and renal outcomes.