From the Guidelines
Jardiance (empagliflozin) is generally not recommended for patients with end-stage renal disease (ESRD). Patients with ESRD, especially those on dialysis, should not take Jardiance because the medication works by causing the kidneys to remove excess glucose through urine, and this mechanism becomes ineffective when kidney function is severely impaired.
Key Points to Consider
- The FDA specifically states that Jardiance is not recommended for patients with an eGFR below 30 mL/min/1.73m², and it's contraindicated in patients with ESRD, as noted in the study 1.
- The medication would provide little to no glycemic benefit in ESRD patients while potentially increasing the risk of side effects such as volume depletion, hypotension, and electrolyte imbalances.
- For ESRD patients with diabetes, other diabetes medications that don't rely on kidney function for their effectiveness, such as insulin, certain GLP-1 receptor agonists, or DPP-4 inhibitors, would be more appropriate treatment options, as suggested by the guidelines in 2 and 3.
- Always consult with a nephrologist or endocrinologist for personalized medication recommendations for diabetes management in the context of ESRD, considering the latest guidelines and evidence from studies like 4.
Additional Considerations
- The use of SGLT2 inhibitors like empagliflozin in patients with advanced CKD has been explored in trials, showing benefits in reducing the risk of kidney disease progression and cardiovascular events, but these benefits are most significant in patients with eGFR above 20 mL/min/1.73m², as discussed in 3 and 4.
- The selection of specific agents for patients with type 2 diabetes and CKD may depend on comorbidity and CKD stage, with SGLT2 inhibitors being more useful for patients at high risk of CKD progression, as noted in 3.
From the FDA Drug Label
JARDIANCE is contraindicated in patients with severe renal impairment, end-stage renal disease, or dialysis (4) Assess renal function before initiating JARDIANCE. Do not initiate JARDIANCE if eGFR is below 45 mL/min/1.73 m2 (2.2) Discontinue JARDIANCE if eGFR falls persistently below 45 mL/min/1.73 m2 (2. 2) 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)].
ESRD patients should not take Jardiance due to the contraindication in patients with end-stage renal disease 5.
From the Research
ESRD Patients and Jardiance
- ESRD (End-Stage Renal Disease) patients have limited treatment options for managing their condition, and the use of certain medications, such as Jardiance (empagliflozin), may be restricted due to their renal impairment 6.
- However, studies have shown that empagliflozin can be safe and effective in patients with type 2 diabetes and moderate to severe chronic kidney disease (CKD) 7.
- The safety of empagliflozin in patients with ESRD is not well established, but it may be considered as an option for those with type 2 diabetes and significant cardiovascular risk factors 8, 9.
- Empagliflozin has been shown to have a favorable effect on non-glycemic outcomes, including modest reductions in body weight and blood pressure, which may be beneficial for ESRD patients 9, 10.
Key Considerations
- ESRD patients should be closely monitored for signs of protein-energy wasting and malnutrition, as well as for potential adverse effects of empagliflozin, such as genital infections, kidney failure, and diabetic ketoacidosis 6, 8.
- The decision to initiate empagliflozin in ESRD patients should be made on a case-by-case basis, taking into account the individual patient's medical history, current medications, and potential risks and benefits 7, 9.
- Further research is needed to fully understand the safety and efficacy of empagliflozin in ESRD patients, particularly in those with advanced CKD or those undergoing dialysis 7, 10.