From the Guidelines
Jardiance (empagliflozin) can be continued in patients with acute kidney injury (AKI) if they are already on the medication, but it should not be initiated in patients with AKI. The decision to continue or discontinue Jardiance in AKI should be based on the individual patient's clinical context and the potential benefits and risks of the medication. According to the 2022 consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1, SGLT2 inhibitors like Jardiance have been shown to have consistent efficacy and safety across studied ranges of eGFR, and can be initiated for most patients with type 2 diabetes and eGFR ≥20 ml/min/1.73 m2. However, in patients with AKI, the medication should be used with caution, and the patient's volume status and kidney function should be closely monitored. Some key considerations for using Jardiance in patients with AKI include:
- Monitoring for hypovolemia and considering proactive dose reduction of diuretics in patients at high risk
- Holding Jardiance during illness or periods of acute stress
- Educating patients about the signs and symptoms of diabetic ketoacidosis and the importance of seeking immediate medical attention if they occur
- Considering the potential benefits and risks of Jardiance in the context of the patient's overall clinical condition, including their kidney function, volume status, and underlying medical conditions. It's also important to note that the EMPA-KIDNEY trial, which is currently ongoing, may provide further guidance on the use of SGLT2 inhibitors like Jardiance in patients with kidney disease, including those with AKI 1.
From the FDA Drug Label
5.3 Acute Kidney Injury and Impairment in Renal Function JARDIANCE causes intravascular volume contraction [see Warnings and Precautions (5. 1)] and can cause renal impairment [see Adverse Reactions (6. 1)]. There have been postmarketing reports of acute kidney injury, some requiring hospitalization and dialysis, in patients receiving SGLT2 inhibitors, including JARDIANCE; some reports involved patients younger than 65 years of age 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 [see Dosage and Administration (2.2), Contraindications (4) and Use in Specific Populations (8.6)].
Jardiance is not used to treat Acute Kidney Injury (AKI). In fact, its use is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m2 and not recommended when eGFR is persistently less than 45 mL/min/1.73 m2. If AKI occurs, Jardiance should be discontinued promptly. 2
From the Research
Use of Jardiance in AKI
- Jardiance, also known as empagliflozin, is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that has been studied for its potential effects on acute kidney injury (AKI) 3, 4, 5.
- One study found that empagliflozin improved survival in a mouse model of lipopolysaccharide-induced septic shock and reduced systemic and renal inflammation 3.
- Another study reported a case of acute interstitial nephritis due to empagliflozin, which was confirmed by renal biopsy 4.
- A prospective, placebo-controlled study found that empagliflozin reduced markers of AKI in patients with acute decompensated heart failure 5.
- The management of AKI typically involves identifying and addressing the underlying cause, and may include conservative management or renal replacement therapy 6, 7.
Potential Benefits and Risks
- Empagliflozin may have potential benefits in reducing morbidity and mortality associated with AKI, particularly in patients with sepsis or acute decompensated heart failure 3, 5.
- However, empagliflozin may also be associated with risks such as acute interstitial nephritis, and its use should be carefully monitored in patients with AKI 4.
- Further research is needed to fully understand the effects of empagliflozin on AKI and to determine its potential role in the management of this condition 3, 5.