Jardiance Use with GFR 55
Jardiance (empagliflozin) is safe and appropriate for a patient with a GFR of 55 mL/min/1.73 m², and should be initiated at the standard dose of 10 mg once daily for both glycemic control and cardiovascular/renal protection. 1, 2
Evidence Supporting Use at This GFR Level
Your patient's GFR of 55 falls into the stage 3a chronic kidney disease category (eGFR 45-59 mL/min/1.73 m²), which is well within the safe range for empagliflozin initiation:
- No dose adjustment is required when eGFR is ≥45 mL/min/1.73 m², and the standard 10 mg or 25 mg daily dose can be used for glycemic control 1
- The FDA label explicitly states that empagliflozin was studied in 91 patients with eGFR between 45-60 mL/min/1.73 m², demonstrating both efficacy and safety in this population 1
- A dedicated phase 3 trial in patients with stage 2 and 3 CKD showed that empagliflozin 25 mg reduced HbA1c by 0.42% compared to placebo in stage 3 CKD patients (eGFR 30-60 mL/min/1.73 m²) with excellent tolerability 2
Expected Efficacy at GFR 55
While empagliflozin remains effective at this GFR level, you should understand the nuances:
- Glucose-lowering efficacy is somewhat reduced compared to normal renal function, but still clinically meaningful 1, 3
- Urinary glucose excretion decreases as GFR declines—at GFR 55, expect approximately 15-20% less glucose excretion than with normal renal function 3
- Cardiovascular and renal protective benefits are fully preserved at this GFR level, independent of the glucose-lowering effect 4
Renal Protection Benefits
The most compelling reason to use Jardiance at GFR 55 is its nephroprotective effect:
- Empagliflozin reduces the risk of incident or worsening nephropathy by 39% (HR 0.61,95% CI 0.53-0.70) 4
- It reduces the risk of doubling serum creatinine by 44% and need for renal replacement therapy by 55% 4
- These renal benefits were demonstrated in patients with baseline eGFR ≥30 mL/min/1.73 m², making your patient with GFR 55 an ideal candidate 4
Practical Implementation
Dosing algorithm:
- Start with empagliflozin 10 mg once daily 1
- If additional glycemic control is needed after 4-12 weeks, increase to 25 mg once daily 1
- Continue therapy even if GFR subsequently declines below 45 mL/min/1.73 m², as cardiovascular/renal benefits persist 1, 4
Safety Monitoring at GFR 55
Key precautions specific to this GFR level:
- Volume depletion risk is increased with declining renal function—assess volume status before initiation and consider reducing concurrent diuretic doses 1
- Check eGFR within 1-2 weeks after starting empagliflozin, as a transient dip of 3-5 mL/min/1.73 m² is expected and reversible 5
- Monitor for urinary tract infections, which occurred in 15.7% of patients ≥75 years on empagliflozin 10 mg versus 10.5% on placebo 1
- Educate about genital mycotic infections, which are the most common adverse effect 1, 6
Critical Safety Considerations
Withhold empagliflozin during:
- Acute illness with reduced oral intake, fever, vomiting, or diarrhea 5
- At least 3 days before major surgery or procedures requiring prolonged fasting 5
Monitor for euglycemic diabetic ketoacidosis, which can occur even with normal blood glucose levels—symptoms include malaise, nausea, vomiting, or abdominal pain 5, 6
Common Pitfall to Avoid
Do not discontinue empagliflozin if GFR subsequently falls below 45 mL/min/1.73 m²—the cardiovascular and renal protective benefits persist even when glucose-lowering efficacy diminishes 1, 4. The drug can be continued until GFR falls below 30 mL/min/1.73 m² (or even 20 mL/min/1.73 m² per some guidelines) 5, 1