From the Guidelines
Jardiance (empagliflozin) may help reduce the risk of hyperkalemia in certain patients, particularly those with chronic kidney disease or heart failure, by improving kidney function, reducing aldosterone levels, and increasing urine flow, as suggested by studies such as 1 and 1. When considering the use of Jardiance in patients at risk for hyperkalemia, it's essential to weigh the potential benefits against the risks. The mechanism of action of SGLT2 inhibitors like Jardiance involves increasing glucose excretion through the kidneys, which can indirectly affect potassium levels. However, Jardiance is not specifically approved as a treatment for hyperkalemia. Some key points to consider:
- Patients with existing hyperkalemia should have their potassium levels monitored regularly when starting Jardiance, typically at 10mg or 25mg daily.
- Those taking medications that can raise potassium levels (like ACE inhibitors, ARBs, or potassium-sparing diuretics) should be particularly vigilant, as noted in studies such as 1 and 1.
- The risk of hyperkalemia during treatment with ACE inhibitors/ARBs is dose-dependent, amplified by both diabetes and chronic kidney disease, and further increased by the addition of an MRA, as discussed in 1.
- Regular monitoring of serum creatinine and potassium is crucial during treatment with an ACE inhibitor, ARB, or diuretic, especially among patients with reduced glomerular filtration, as recommended in 1. If you're concerned about hyperkalemia, it's crucial to discuss with your healthcare provider whether Jardiance might be appropriate as part of your treatment plan, especially if you have diabetes with kidney or heart complications.
From the Research
Jardiance and Hyperkalemia
- Jardiance, also known as empagliflozin, is an SGLT2 inhibitor used in the treatment of type 2 diabetes mellitus.
- The risk of hyperkalemia is increased in diabetes, particularly in patients with renal impairment or those receiving angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or potassium-sparing diuretics 2.
- However, studies have shown that SGLT2 inhibitors like dapagliflozin are not associated with an increased risk of hyperkalemia or severe hypokalemia in patients with type 2 diabetes mellitus 2.
- In patients with chronic kidney disease, the use of ACE inhibitors and ARBs can slow the progression of renal disease, but may also increase the risk of hyperkalemia 3, 4, 5.
- The appropriate use of diuretics can mitigate against profound increases in serum potassium, and the interruption of ACE inhibitor or ARB therapy may contribute to a certain recovery of renal function and delay the onset of dialysis 3, 4.
- It is essential to monitor serum potassium levels and adjust treatment accordingly to minimize the risk of hyperkalemia in patients with chronic kidney disease 3, 4, 5.
Management of Hyperkalemia
- Urgent management of hyperkalemia is warranted for patients with potassium levels of 6.5 mEq/L or greater, if ECG manifestations of hyperkalemia are present regardless of potassium levels, or if severe muscle symptoms occur 6.
- Treatment options for hyperkalemia include intravenous calcium, intravenous insulin, and inhaled beta agonists, as well as hemodialysis in urgent situations 6.
- For patients with less severe hyperkalemia, renal elimination drugs or gastrointestinal elimination drugs may be used 6.