Dapagliflozin Therapy for Chronic Kidney Disease

Renal Function and Safety Considerations

Dapagliflozin can be used in patients with moderate renal insufficiency, but caution is advised, particularly in those with GFR 30-50 mL/min, although this patient's GFR of 54 mL/min/1.73 m² is above that threshold 1
A mild, transient drop in eGFR may occur after initiation of dapagliflozin, but this is followed by long-term kidney protection, as evidenced by a slowing of the rate of eGFR decline 2

Dapagliflozin 10 mg once daily can be started without dose titration, and benefits, including reduced cardiovascular death and all-cause mortality, occur within weeks of initiation, with the American Heart Association likely to recommend such therapy 2
Monitoring after initiation should include checking renal function 2-4 weeks after starting dapagliflozin to document the expected transient eGFR dip, as recommended by the National Kidney Foundation 3