Is Jardiance (Empagliflozin) safe in patients with Acute Kidney Injury (AKI)?

From the Guidelines

Jardiance (empagliflozin) can be safely continued in patients with acute kidney injury (AKI) unless the patient is not tolerating treatment or kidney replacement therapy (KRT) is initiated, as SGLT2i use appears to protect patients from AKI 1.

Key Considerations for Jardiance Use in AKI

• The mechanism of action of SGLT2 inhibitors like Jardiance involves increasing urinary glucose excretion, which depends on adequate kidney function but does not necessarily preclude their use in AKI.
• Studies, including the DAPA-CKD trial, have shown that SGLT2 inhibitors can be safely used in patients with chronic kidney disease (CKD) and may offer protection against AKI 1.
• Protocols for trials like CREDENCE and DAPA-CKD specified continuation of the study drug when eGFR fell below initiation thresholds, suggesting that these medications can be continued in the context of declining kidney function unless there are specific contraindications 1.
• Monitoring for hypovolemia, hypoglycemia, and diabetic ketoacidosis is crucial when using SGLT2 inhibitors, especially in patients with AKI or those at risk for these conditions 1.
• The risk of genital mycotic infections, a known complication of SGLT2 inhibitors, can be mitigated with daily hygienic measures, and most infections are easily treated 1.

Clinical Decision Making

• Healthcare providers should closely monitor kidney function and adjust the treatment plan as necessary for patients with AKI who are taking Jardiance.
• The decision to continue or discontinue Jardiance in patients with AKI should be based on individual patient factors, including the severity of AKI, the presence of other comorbidities, and the patient's overall clinical condition.
• Regular follow-up and reassessment of volume status and glycemia are important for patients taking SGLT2 inhibitors, particularly in the context of AKI 1.

From the FDA Drug Label

Acute Kidney Injury Inform patients that acute kidney injury has been reported during use of JARDIANCE Advise patients to seek medical advice immediately if they have reduced oral intake (such as due to acute illness or fasting) or increased fluid losses (such as due to vomiting, diarrhea, or excessive heat exposure), as it may be appropriate to temporarily discontinue JARDIANCE use in those settings [see Warnings and Precautions (5. 3)]. The efficacy and safety of JARDIANCE have not been established in patients with severe renal impairment, with ESRD, or receiving dialysis. JARDIANCE is not expected to be effective in these patient populations [see Dosage and Administration (2.2), Contraindications (4) and Warnings and Precautions (5.1,5.3)].

Jardiance Safety with AKI: Jardiance may not be safe for use in patients with Acute Kidney Injury (AKI), as it may increase the risk of worsening renal function. Patients with AKI should seek medical advice immediately if they experience reduced oral intake or increased fluid losses.

• Key Points:
  • Jardiance may increase the risk of AKI
  • Patients with AKI should be monitored closely
  • Jardiance is not expected to be effective in patients with severe renal impairment, ESRD, or receiving dialysis
  • Patients should seek medical advice immediately if they experience reduced oral intake or increased fluid losses 2 2

From the Research

Jardiance and AKI Safety

• The safety of Jardiance (empagliflozin) in patients with acute kidney injury (AKI) has been investigated in several studies 3, 4, 5.
• A study published in ESC heart failure found that empagliflozin reduced markers of AKI in patients with acute decompensated heart failure 3.
• Another study published in Scientific reports found that empagliflozin attenuated AKI after myocardial infarction in diabetic rats 4.
• A review published in Kidney & blood pressure research suggested that empagliflozin might be a new approach for the prevention of AKI, based on its effects on renal outcomes in clinical trials 5.
• However, it is essential to note that the FDA has warned of the risk of AKI for canagliflozin and dapagliflozin, and the clinical data on AKI is mainly based on safety data, such as creatine measurements 5.
• The management of AKI typically involves identifying and reversing the underlying cause, as well as supportive care, such as treatment of complications and short-term renal replacement therapy 6, 7.

Key Findings

• Empagliflozin has been shown to reduce markers of AKI in patients with acute decompensated heart failure 3.
• Empagliflozin has been found to attenuate AKI after myocardial infarction in diabetic rats 4.
• The SGLT2 inhibitor empagliflozin might have beneficial effects on the prevention of AKI, based on its effects on renal outcomes in clinical trials 5.
• AKI is a common and heterogeneous condition that requires early determination of etiology, management, and long-term follow-up 6, 7.