From the Guidelines
Jardiance (empagliflozin) is not contraindicated in chronic kidney disease (CKD), but its use depends on the severity of kidney impairment, and it can be initiated in patients with an estimated glomerular filtration rate (eGFR) of 20 mL/min/1.73 m² or higher, as supported by the most recent evidence from 2023 1. For patients with CKD, the selection of specific agents may depend on comorbidity and CKD stage, and SGLT2 inhibitors like Jardiance may be more useful for patients at high risk of CKD progression, as they appear to have large beneficial effects on CKD incidence, as noted in the 2022 guideline 1. The benefits of Jardiance in CKD patients include reducing the risk of kidney disease progression, cardiovascular death, and hospitalization for heart failure, as demonstrated in several large clinical trials, including the EMPA-REG OUTCOME trial and the DAPA-CKD study 1. Regular monitoring of kidney function is recommended when using Jardiance in CKD patients to ensure appropriate dosing and safety, and it is reasonable to continue therapy if the eGFR falls below the initiation thresholds unless the patient is not tolerating treatment or kidney replacement therapy (KRT) is initiated, as suggested by the 2022 consensus report 1. Some key considerations when using Jardiance in CKD patients include:
- Monitoring for hypovolemia and hypoglycemia, as these can occur with SGLT2 inhibitors, although the absolute risks are low, especially at low eGFR 1
- Counseling on genital hygiene to reduce the risk of genital mycotic infections, which are a known complication of SGLT2 inhibitors 1
- Maintaining at least low-dose insulin and considering pausing SGLT2i treatment during periods of acute illness or stressors to mitigate the risk of euglycemic ketoacidosis 1
- Regularly assessing volume status and glycemia to ensure safe use of Jardiance in CKD patients 1.
From the FDA Drug Label
Severe renal impairment, end-stage renal disease, or dialysis (4) 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)].
Jardiance is contraindicated in patients with severe renal impairment, end-stage renal disease, or dialysis. The drug label explicitly states that Jardiance is not expected to be effective in these patient populations and is contraindicated in severe renal impairment, end-stage renal disease, or dialysis 2.
From the Research
Jardiance (Empagliflozin) in Chronic Kidney Disease (CKD)
- Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been shown to have a nephroprotective effect in patients with CKD, with or without diabetes 3, 4, 5, 6, 7.
- The EMPA-KIDNEY trial demonstrated a reduction of 28% in the primary composite outcome of kidney disease progression or cardiovascular death in patients with CKD treated with empagliflozin compared to placebo 3.
- Subgroup analyses of the EMPA-KIDNEY trial showed that the effects of empagliflozin on kidney disease progression were similar across different primary kidney diseases, including diabetic kidney disease, glomerular disease, and hypertensive or renovascular disease 4.
- Empagliflozin has been associated with slower progression of kidney disease and lower rates of clinically relevant renal events in patients with type 2 diabetes at high cardiovascular risk 7.
- Long-term follow-up of the EMPA-KIDNEY trial showed that the cardiorenal benefits of empagliflozin persisted for up to 12 months after discontinuation of the drug 6.
Key Findings
- Empagliflozin reduces the risk of kidney disease progression and cardiovascular death in patients with CKD 3, 4, 6.
- Empagliflozin has a nephroprotective effect in patients with CKD, regardless of the presence of diabetes 3, 4, 5, 7.
- The effects of empagliflozin on kidney disease progression are similar across different primary kidney diseases 4.