Can End-Stage Renal Disease (ESRD) patients take Jardiance (Empagliflozin)?

From the Guidelines

Jardiance (empagliflozin) is generally not recommended for patients with end-stage renal disease (ESRD). Patients with ESRD, particularly 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 less than 30 mL/min/1.73m², and it's contraindicated in patients with ESRD, as noted in the study by 1.
• The medication would provide minimal glycemic benefit while potentially increasing the risk of side effects such as volume depletion, hypotension, and electrolyte imbalances in ESRD patients.
• If you have ESRD and need medication to manage diabetes, other options like insulin, certain GLP-1 receptor agonists, or dipeptidyl peptidase-4 (DPP-4) inhibitors may be more appropriate, as suggested by 1 and 1.
• Always consult with your nephrologist and endocrinologist before making any changes to your medication regimen, as they can recommend diabetes treatments better suited for patients with severely compromised kidney function.

Recent Guidelines and Studies

• A recent study published in 2023, 1, highlights the importance of considering the latest guidelines and research when managing diabetes in patients with ESRD.
• The study emphasizes the need for careful consideration of the potential benefits and risks of using SGLT2 inhibitors, such as Jardiance, in patients with advanced CKD or ESRD.

Recommendations for Clinical Practice

• In clinical practice, it is essential to prioritize the patient's overall health and well-being, considering factors such as morbidity, mortality, and quality of life when making treatment decisions.
• Healthcare providers should carefully evaluate the potential benefits and risks of using Jardiance or other SGLT2 inhibitors in patients with ESRD, taking into account the latest research and guidelines, as well as individual patient factors, as recommended by 1 and 1.

From the FDA Drug Label

Severe renal impairment, end-stage renal disease, or dialysis (4) 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)

ESRD patients should not take Jardiance due to the contraindication of severe renal impairment, end-stage renal disease, or dialysis. The drug label explicitly states that Jardiance should not be initiated in patients with an eGFR below 45 mL/min/1.73 m2 and should be discontinued if the eGFR falls persistently below this threshold 2.

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 like Jardiance (empagliflozin) may be considered 3.
• Jardiance is a sodium-glucose cotransporter 2 (SGLT2) inhibitor used to treat type 2 diabetes, and its effects on patients with ESRD are not fully understood 4.
• Studies have shown that empagliflozin can reduce cardiovascular morbidity and mortality in patients with type 2 diabetes and established cardiovascular disease, including those with chronic kidney disease 5, 6.
• However, the efficacy of empagliflozin in patients with ESRD is decreased due to reduced renal function, which affects the drug's ability to lower glucose levels 7, 6.
• The use of Jardiance in ESRD patients may be considered on a case-by-case basis, taking into account the patient's individual needs and medical history 5, 6.

Key Considerations

• Patients with ESRD and diabetes mellitus requiring medication may be treated with insulin, which is the preferred treatment option 3.
• The use of Jardiance in ESRD patients may require careful monitoring of renal function, blood pressure, and electrolyte levels due to the potential risks of volume depletion and hypotension 4, 7.
• Further studies are needed to fully understand the effects of Jardiance on ESRD patients and to determine the optimal treatment strategies for this population 6.