Management of Abdominal Pain in Outpatients with Impaired Renal Function Taking Empagliflozin

Introduction to Management

• For an outpatient with impaired renal function experiencing abdominal pain while on Jardiance (empagliflozin), the American Journal of Kidney Diseases recommends temporarily discontinuing the medication immediately and ensuring adequate hydration until symptoms resolve or for up to 3 days, whichever comes first 1

Temporarily Discontinuing Empagliflozin

• The American Journal of Kidney Diseases suggests that empagliflozin should be stopped when patients experience significant symptoms like abdominal pain, especially with impaired renal function, consistent with sick day medication guidance for SGLT2 inhibitors 1

Assessing Hydration Status

• Ensure patient can maintain adequate fluid intake, and if unable to maintain hydration, consider urgent medical evaluation, monitoring for signs of volume depletion (lightheadedness, dizziness, decreased urine output) 1

Monitoring Renal Function

• Check eGFR and electrolytes promptly, comparing with baseline values to assess for acute kidney injury, as recommended by the American Journal of Kidney Diseases and Kidney International [2] [3]

Patient Guidance

• Patients should contact their healthcare provider immediately if they are unable to maintain fluid intake, symptoms persist beyond 72 hours, vomiting occurs more than 4 times in 12 hours, or they develop reduced level of consciousness, confusion, significant drop in blood pressure, or moderate or high ketones (if testing available) 1

Empagliflozin and Renal Function

• For patients with eGFR <45 mL/min/1.73m², empagliflozin is not recommended for glycemic control, but it can be used for cardiovascular and renal protection with eGFR as low as 20-30 mL/min/1.73m², according to the Journal of the American College of Cardiology 4

Monitoring After Restarting

• Check renal function within 1 week of restarting medication, expecting a mild initial decrease in eGFR, which is generally not concerning, as suggested by the American Journal of Kidney Diseases 2

Special Considerations

• If renal function has worsened, reassess the appropriateness of continuing empagliflozin, and consider dose adjustments for other medications that may be affected by changes in renal function, as recommended by the American Journal of Kidney Diseases 2

Medication Review

• Patients with CKD often have complex medication regimens requiring periodic comprehensive review, considering all medications that may need dose adjustment based on renal function, according to Kidney International and the American Journal of Kidney Diseases [2] [3]