Dapagliflozin Use in Patients with Kidney Disease

Introduction to Dapagliflozin Guidelines

• The Kidney Disease Outcomes Quality Initiative (KDOQI) states that there is not enough evidence to suggest that SGLT2 inhibitors like dapagliflozin are effective in patients receiving kidney replacement therapy 1
• The KDOQI Work Group recommends that dapagliflozin should not be used in patients on dialysis due to lack of proven efficacy and safety data 1

Patient Selection and Dapagliflozin Initiation

• Dapagliflozin can be initiated in patients with estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m², but not for those on dialysis, as recommended by the Kidney International guidelines 2
• For patients with chronic kidney disease (CKD) who are not yet on dialysis, dapagliflozin can be initiated in patients with eGFR ≥20 mL/min/1.73 m², according to the American Journal of Kidney Diseases and Kidney International guidelines 1, 2

Safety and Efficacy Concerns

• The glucose-lowering efficacy of dapagliflozin decreases substantially with declining renal function, making it ineffective for glycemic control in patients with eGFR <45 mL/min/1.73 m², as noted by the Praxis Medical Insights guidelines 3
• Potential risks in dialysis patients include genital mycotic infections and urinary tract infections, which are common adverse effects of SGLT2 inhibitors, according to the Praxis Medical Insights guidelines 3

Ongoing Research and Clinical Approach

• The KDOQI guidelines note that ongoing trials are exploring the potential benefits of SGLT2 inhibitors in dialysis and transplant patients, and until these trials are completed, dapagliflozin should not be used in dialysis patients 1
• For patients already on dialysis, the American Journal of Kidney Diseases guidelines recommend not initiating dapagliflozin due to lack of evidence for efficacy and safety 1