You'll hear debate over whether SGLT2 inhibitors (Jardiance, etc) harm or help the kidneys in type 2 diabetes patients.
New warnings suggest that canagliflozin (Invokana, etc.) or dapagliflozin (Farxiga, etc.) can cause acute kidney INJURY. But other recent evidence suggests the SGLT2 inhibitors, or "flozins," may be PROTECTIVE.
For example, flozins can increase serum creatinine...usually within the first month. This is likely due to their diuretic effect...and more common in patients with dehydration, poor kidney function, or on an NSAID, diuretic, ACEI, or ARB.
On the other hand, adding Jardiance (empagliflozin) to an ACEI or ARB seems to further slow progression of nephropathy in about one in 16 patients over 3 years...but delays dialysis in only one in 333 patients.
Think of this as similar to the situation with ACEIs and ARBs. These can initially cause a bump in serum creatinine...but in the long run they seem to protect renal function in diabetes patients.
Continue to focus on blood pressure control to protect the kidneys.
For more renal protection, think about suggesting Jardiance as an add-on to an ACEI or ARB. But avoid Jardiance in severe renal impairment.
For now, consider Jardiance the preferred flozin...since it also reduces cardiovascular risk in diabetes patients with CV disease. It's too early to say whether other flozins have similar renal or CV benefits.
Suggest monitoring patients on flozins as you would with an ACEI or ARB. For example, suggest checking serum creatinine before starting a flozin...one to two weeks later...and with dose increases. Expect these meds to be stopped or held if serum creatinine increases significantly.
Click on PL VOICES to hear our team debate renal outcomes of diabetes meds. And see our chart, Management of Microalbuminuria: Focus on Pharmacotherapy, for evidence about ACEIs, ARBs, and diabetes meds.
N Engl J Med Published online Jun 14, 2016; doi:10.1056/NEJMoa1515920. www.fda.gov/Drugs/DrugSafety/ucm505860.htm (7-21-16).