Indications for Prescribing Dapagliflozin with Elevated Microalbumin-to-Creatinine Ratio

Understanding Microalbuminuria

Microalbuminuria is defined as urinary albumin excretion of 30-299 mg/24h or 30-299 mg/g creatinine (3-29 mg/mmol) on a random spot urine sample, according to the American Diabetes Association 1, 2
A microalbumin-to-creatinine ratio of 4.5 mg/mmol falls within the moderately increased albuminuria range (3-29 mg/mmol), indicating early kidney damage, as stated by the American Diabetes Association 1, 3
Diagnosis requires confirmation with 2 out of 3 abnormal specimens collected within a 3-6 month period due to day-to-day variability in urinary albumin excretion, as recommended by the American Diabetes Association 4, 1
Transient elevations can occur with exercise, infection, fever, heart failure, marked hyperglycemia, hypertension, urinary tract infections, and hematuria, according to the American Diabetes Association 5, 2

Verify elevated microalbumin-to-creatinine ratio with at least 2 out of 3 specimens over 3-6 months, as recommended by the American Diabetes Association 4, 1
Rule out transient causes of microalbuminuria (exercise, infection, fever, heart failure, marked hyperglycemia), according to the American Diabetes Association 5, 2

Ensure patient is on standard kidney protective therapy (ACE inhibitor or ARB), as recommended by the American Diabetes Association 4, 6

Continue monitoring urinary albumin-to-creatinine ratio every 6 months to assess treatment response, as recommended by the American Diabetes Association 1
A reduction in albuminuria of ≥30% is considered a positive response to therapy, according to the American Diabetes Association 1