Indications and Usage of Dapagliflozin

Chronic Kidney Disease

The American College of Cardiology recommends dapagliflozin to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression, with a 39% reduction in the composite outcome of sustained decline in eGFR of at least 50%, end-stage renal disease, or renal or cardiovascular death, as demonstrated by the DAPA-CKD study 1
Dapagliflozin is recommended for patients with eGFR between 25-75 mL/min/1.73 m², with albuminuria (UACR 200-5000 mg/g), for cardiovascular and renal protection 1

The American Heart Association suggests that dapagliflozin is effective in patients with heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), with a 26% reduction in the composite of worsening heart failure or cardiovascular death in patients with HFrEF, regardless of diabetes status, as shown in the DAPA-HF trial 2
The DAPA-HF and DELIVER trials demonstrated that dapagliflozin reduces the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits in adults with heart failure, with an 18% reduction in the composite of worsening heart failure or cardiovascular death in patients with HFpEF 2

The American Diabetes Association notes that dapagliflozin reduces the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and either established cardiovascular disease or multiple cardiovascular risk factors, with a 27% reduction in hospitalization for heart failure in patients with type 2 diabetes with established cardiovascular disease or multiple risk factors, as demonstrated by the DECLARE-TIMI 58 trial 2

The American College of Cardiology recommends assessing renal function prior to initiation and periodically thereafter, and assessing volume status before starting dapagliflozin, with correction of volume depletion if present 1, 2
The Journal of the American College of Cardiology suggests discontinuing dapagliflozin at least 3 days before planned surgery to prevent postoperative ketoacidosis, and monitoring for genital mycotic infections, urinary tract infections, volume depletion, and euglycemic diabetic ketoacidosis 2, 3

The American Heart Association notes that cardiovascular and renal benefits of dapagliflozin appear to be independent of glucose-lowering effects, as benefits are seen in patients with and without diabetes, with preserved benefits at lower eGFR levels 1, 2
When initiating dapagliflozin for heart failure or renal protection in patients already on diuretics, consider reducing diuretic dose to minimize risk of volume depletion, as recommended by the American College of Cardiology 2