What is the role of Jardiance (Empagliflozin) in treating microalbuminuria?

From the Guidelines

Jardiance (empagliflozin) is recommended for patients with microalbuminuria, particularly those with type 2 diabetes, as it has been shown to reduce the risk of incident or worsening nephropathy by 39% compared to placebo 1.

Key Considerations

• The medication should be prescribed at 10 mg once daily, which can be increased to 25 mg daily if needed and tolerated.
• Jardiance works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, reducing glucose reabsorption and increasing glucose excretion in urine.
• Beyond glycemic control, Jardiance has demonstrated kidney-protective effects by reducing intraglomerular pressure, decreasing hyperfiltration, and providing anti-inflammatory benefits.

Important Mechanisms and Benefits

• Reduces microalbuminuria and slows progression of diabetic kidney disease.
• Provides anti-inflammatory benefits and reduces intraglomerular pressure.
• Decreases hyperfiltration, which can help protect the kidneys.

Monitoring and Precautions

• Patients should maintain adequate hydration while taking Jardiance.
• Regular kidney function testing is important during treatment.
• Potential side effects include genital mycotic infections, urinary tract infections, and volume depletion.

Optimal Treatment Approach

• Jardiance should be used alongside other measures like blood pressure control, diabetes management, and lifestyle modifications.
• Dietary protein moderation and smoking cessation are also important for optimal results.
• Blood pressure levels < 140/90 mmHg are generally recommended to reduce CVD mortality and slow CKD progression among people with diabetes, with lower targets considered for patients with CKD or albuminuria 1.

From the Research

Jardiance for Microalbumin

• Jardiance, also known as empagliflozin, is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used to treat type 2 diabetes mellitus (T2DM) 2.
• The use of Jardiance has been shown to reduce the risk of major adverse cardiovascular events in patients with T2DM at high risk for cardiovascular events 3.
• In terms of microalbumin, which is an early sign of increased urinary albumin excretion and a marker of kidney damage, Jardiance has been found to have a beneficial effect 4.
• A study published in The Lancet Diabetes & Endocrinology found that empagliflozin reduced the urinary albumin-to-creatinine ratio (UACR) in patients with T2DM and established cardiovascular disease, regardless of their baseline albuminuria status 4.
• The study found that after short-term treatment with empagliflozin, the UACR was reduced by 25% in patients with microalbuminuria and 32% in patients with macroalbuminuria, compared to placebo 4.
• The reductions in UACR were maintained with empagliflozin during long-term treatment, and patients treated with empagliflozin were more likely to experience a sustained improvement from microalbuminuria to normoalbuminuria or from macroalbuminuria to microalbuminuria or normoalbuminuria 4.

Mechanism of Action

• Jardiance works by reducing renal tubular glucose reabsorption, thereby decreasing blood glucose levels without stimulating insulin release 5.
• This mechanism of action also has a diuretic effect, which can lead to a reduction in blood pressure and a decrease in the risk of heart failure 2.

Clinical Implications

• The use of Jardiance may be beneficial in patients with T2DM and microalbuminuria, as it has been shown to reduce the UACR and slow the progression of kidney disease 3, 4.
• However, the adverse event profile of Jardiance should be considered, including the risk of genital infections, kidney failure, and diabetic ketoacidosis 2.