At what level of Glomerular Filtration Rate (GFR) can Jardiance (Empagliflozin) be administered?

From the Guidelines

Jardiance (empagliflozin) should not be initiated in patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73m², and its use is not recommended for glycemic control in patients with eGFR below this threshold, as indicated in the most recent and highest quality study 1. For patients with eGFR between 45-60 mL/min/1.73m², dose adjustment is not required, though monitoring kidney function is recommended. Some key points to consider when prescribing Jardiance in patients with reduced kidney function include:

• The glucose-lowering efficacy of Jardiance may be reduced in patients with declining kidney function, as its mechanism of action relies on the inhibition of SGLT2 in the kidneys to prevent glucose reabsorption.
• Patients with severely impaired kidney function may be at higher risk for adverse effects like volume depletion and acute kidney injury.
• Regular monitoring of kidney function is essential for all patients on Jardiance, especially those with pre-existing kidney impairment, as recommended by recent guidelines 1. The reason for these restrictions is that Jardiance works by inhibiting SGLT2 in the kidneys, and this mechanism becomes less effective with declining kidney function, as discussed in a recent review of SGLT2 inhibitors 1. Additionally, the use of Jardiance in patients with reduced kidney function should be guided by the principles of minimizing the risk of adverse effects while maximizing the benefits of treatment, as outlined in a recent consensus report on diabetes management in chronic kidney disease 1.

From the FDA Drug Label

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 Use of JARDIANCE is not recommended when eGFR is persistently less than 45 mL/min/1.73 m2 and is contraindicated in patients with an eGFR less than 30 mL/min/1. 73 m2

Jardiance can be given until the GFR is 45 mL/min/1.73 m2 or greater.

• The dose does not need to be adjusted in patients with an eGFR of 45 mL/min/1.73 m2 or greater.
• Jardiance should be discontinued if the eGFR is persistently less than 45 mL/min/1.73 m2 2, 2, 2.

From the Research

Dosage and Administration of Jardiance

• Jardiance (empagliflozin) can be administered to patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) of at least 30 ml per minute per 1.73 m(2) of body-surface area 3.
• The dosage of Jardiance is not directly related to the eGFR, but its effectiveness in lowering glucose levels decreases with declining renal function 4.
• Jardiance can be used in patients with eGFR ≥30 mL·min-1·1.73 m-2, and its effects on clinical outcomes are consistent across categories of eGFR 4.

Renatical Considerations

• Patients with prevalent kidney disease at baseline (eGFR <60 mL·min-1·1.73 m-2 and/or urine albumin-creatinine ratio >300 mg/g) can benefit from Jardiance treatment, which reduces the risk of cardiovascular death, all-cause mortality, hospitalization for heart failure, and all-cause hospitalization 4.
• The adverse event profile of Jardiance in patients with eGFR <60 mL·min-1·1.73 m-2 is consistent with the overall trial population 4.

Clinical Outcomes

• Jardiance improves clinical outcomes and reduces mortality in vulnerable patients with type 2 diabetes mellitus, established cardiovascular disease, and chronic kidney disease 4.
• The effects of Jardiance on clinical outcomes are consistent across categories of eGFR and urine albumin-creatinine ratio at baseline 4.