Medication Management for Patients with Reduced Kidney Function

Metformin and Jardiance Considerations

For patients with eGFR 45-59 ml/min/1.73m², metformin can be continued at the current dose of 500mg twice daily without dose reduction, according to the Kidney International guidelines 1, 2
More frequent monitoring of renal function is recommended when eGFR is <60 ml/min/1.73m², at least every 3-6 months, as suggested by Kidney International 1, 2, 3
Consider vitamin B12 monitoring if the patient has been on metformin for more than 4 years, as recommended by Kidney International and Praxis Medical Insights 1, 3
If the patient has additional risk factors such as advanced age or concomitant liver disease, dose reduction could be considered, but is not mandatory at this eGFR level, according to Kidney International 2, 3

Monitor renal function at least every 3-6 months due to eGFR <60 ml/min/1.73m², as recommended by Kidney International and Praxis Medical Insights 1, 2, 3
Monitor glycemic control to ensure treatment goals are being met, according to Kidney International 1, 2
Check vitamin B12 levels if the patient has been on metformin for >4 years, as suggested by Kidney International and Praxis Medical Insights 1, 3
If renal function declines to eGFR <45 ml/min/1.73m², Jardiance would need to be discontinued and metformin dose would need to be reduced to half the maximum recommended dose, according to Kidney International 1

If eGFR declines to 30-44 ml/min/1.73m², reduce metformin to half the maximum dose and discontinue Jardiance, as recommended by Kidney International 1, 2
Consider adding a GLP-1 receptor agonist if eGFR declines to 30-44 ml/min/1.73m², according to Kidney International 1, 2
If eGFR declines to <30 ml/min/1.73m², discontinue both metformin and Jardiance and consider alternative diabetes medications suitable for advanced CKD, as suggested by Kidney International 1, 2