From the Guidelines
Jardiance (empagliflozin) is contraindicated when a patient's estimated glomerular filtration rate (eGFR) falls below 45 mL/min/1.73m², and its use should be avoided and discontinued in patients with eGFR persistently below this threshold. According to the study by Galindo et al 1, the medication's labeling recommends no dose adjustment if eGFR is ≥ 45 mL/min/1.73 m², but advises against use and discontinuation in patients with eGFR persistently < 45 mL/min/1.73 m².
Key Considerations
- The primary concern with using Jardiance in patients with reduced kidney function is the decreased efficacy of the medication and the potential increased risk of adverse effects.
- Regular monitoring of kidney function is crucial for patients taking Jardiance to ensure safe and effective use.
- The study by Galindo et al 1 provides guidance on the use of Jardiance in patients with advanced chronic kidney disease, emphasizing the importance of considering eGFR when making treatment decisions.
Clinical Implications
- For patients with an eGFR above 45 mL/min/1.73m², Jardiance can be used as directed, with regular monitoring of kidney function and adjustment of the treatment plan as needed.
- Patients with an eGFR below 45 mL/min/1.73m² should not be started on Jardiance, and those already taking the medication should have their treatment plan re-evaluated to determine the best course of action.
- The decision to use Jardiance in patients with reduced kidney function should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, as well as the potential risks and benefits of the medication 1.
From the FDA Drug Label
Use of JARDIANCE is not recommended when eGFR is persistently less than 45 mL/min/1.73 m2 and is contraindicated in patients with an eGFR less than 30 mL/min/1. 73 m2 JARDIANCE is contraindicated with a GFR of less than 30 mL/min/1.73 m2 and its use is not recommended with a GFR of less than 45 mL/min/1.73 m2 2.
From the Research
Jardiance Contraindications with GFR
- Jardiance (empagliflozin) is contraindicated in patients with severe renal impairment, as its efficacy and safety have not been established in this population 3, 4.
- The glucose-lowering efficacy of SGLT2 inhibitors, including Jardiance, is dependent on renal function, and their use is not recommended in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 3.
- However, the cardiovascular and renal benefits of SGLT2 inhibition, including Jardiance, appear to be maintained to eGFR levels as low as 30 mL/min/1.73 m2 3.
- Caution is advised when using Jardiance in patients with moderate to severe renal impairment, as they may be at increased risk of adverse reactions, including hypotension and renal failure 4.
- Patients with severe impaired renal function should be monitored closely for signs of renal deterioration, and the use of Jardiance should be avoided or used with caution in these patients 4.