From the Guidelines
Yes, Jardiance (empagliflozin) is used in chronic kidney disease (CKD) to reduce the risk of sustained decline in estimated glomerular filtration rate (eGFR), end-stage kidney disease, cardiovascular death, and hospitalization for heart failure, as supported by the most recent study from 2023 1.
Key Points
- The typical dose is 10 mg once daily, taken in the morning with or without food.
- For patients with CKD, no dose adjustment is needed based on kidney function, though it should not be initiated if eGFR is below 20 mL/min/1.73m².
- Jardiance works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, which reduces glucose reabsorption and increases glucose excretion.
- Beyond glucose control, it provides kidney protection through multiple mechanisms including reducing intraglomerular pressure, decreasing hyperfiltration, and providing anti-inflammatory effects.
- Common side effects include genital mycotic infections, urinary tract infections, and volume depletion, so patients should be monitored for these issues, especially when starting treatment.
Mechanism and Benefits
The use of SGLT2 inhibitors like empagliflozin in CKD has been shown to have beneficial effects on both kidney and cardiovascular outcomes, as demonstrated in several studies including the EMPA-REG OUTCOME and DAPA-CKD trials 1.
Monitoring and Precautions
It is essential to monitor patients for potential side effects and adjust treatment accordingly, considering the risk of hypovolemia, hypoglycemia, and genital mycotic infections 1.
Clinical Guidelines
Recent clinical guidelines, including those from the American Diabetes Association and Kidney Disease: Improving Global Outcomes, recommend the use of SGLT2 inhibitors for patients with CKD to provide both kidney and cardiovascular protective benefits 1.
From the FDA Drug Label
The efficacy and safety of JARDIANCE were evaluated in a study of patients with mild and moderate renal impairment [see Clinical Studies (14.1)]. In this study, 195 patients exposed to JARDIANCE had an eGFR between 60 and 90 mL/min/1.73 m2, 91 patients exposed to JARDIANCE had an eGFR between 45 and 60 mL/min/1. 73 m2 and 97 patients exposed to JARDIANCE had an eGFR between 30 and 45 mL/min/1.73 m2. JARDIANCE is not expected to be effective in patients with severe renal impairment, with ESRD, or receiving dialysis.
Jardiance use in CKD: Jardiance can be used in patients with mild to moderate Chronic Kidney Disease (CKD), but its efficacy and safety have not been established in patients with severe renal impairment, End-Stage Renal Disease (ESRD), or those receiving dialysis 2.
- Key considerations:
- Efficacy decreases with worsening renal function
- Risks of renal impairment, volume depletion, and urinary tract infections increase with worsening renal function
- Not recommended for use in patients with severe renal impairment or ESRD
From the Research
Use of Jardiance in CKD
- Jardiance, also known as empagliflozin, has been studied in patients with chronic kidney disease (CKD) to assess its effects on kidney function decline 3, 4, 5, 6, 7.
- The EMPA-REG OUTCOME trial found that empagliflozin slowed the progression of CKD in patients with type 2 diabetes and cardiovascular disease 3.
- The EMPA-KIDNEY study demonstrated a reduction in the primary composite outcome of progression of CKD or cardiovascular death in patients with CKD, with or without diabetes, treated with empagliflozin 4, 5, 6.
- Empagliflozin has been shown to reduce the risk of progression of kidney disease or death from cardiovascular causes in a wide range of patients with CKD 4, 5, 6.
- The medication has been found to be effective in slowing the rate of progression of CKD among all types of participants, including those with little albuminuria 5.
Key Findings
- Empagliflozin reduced the risk of progression of kidney disease or death from cardiovascular causes by 28% in the EMPA-KIDNEY trial 4.
- The medication halved the chronic slope of estimated glomerular filtration rate (eGFR) decline from -2.75 to -1.37 mL/min per 1.73 m2 per year 5.
- Empagliflozin slowed the progression of kidney disease among patients with or without diabetes and across subgroups defined according to eGFR ranges 6.
- The medication was associated with a lower risk of hospitalization from any cause and a similar rate of serious adverse events compared to placebo 6.