ACUTE AND CHRONIC KIDNEY DISEASE: SGLT2 inhibitors & risk of diabetic ketoacidosis (Sep. 2020) A cohort study from Canad...
Dose of Dapagliflozin (Forxiga) in adults with Renal dysfunction:
DM type II:
Ø Hyperglycemia: The US manufacturer does NOT recommend use; use in other countries is variable (ADA 2020).
Ø Ptns with heart failure and/or atherosclerotic CVS: No dosage adjustment necessary for ptns with HF. The manufacturer in US states there is insufficient data supporting a dose recommendation in ptns without HF.
Ø Diabetic kidney disease (off-label use): Some experts use dapagliflozin off label at a dose of 5 mg once/day in ptns with heavy albuminuria (e.g., urinary albumin >300 mg/d). (Perkovic 2020; Neuen 2019; Wiviott 2019).
Ø Heart failure with EF decline: No dose adjustment is required.
DM, type II: for hyperglycemia control: contraindicated. ☝
Use in ptns with HF and/or ptns with or at risk for atherosclerotic CVS disease: The US manufacturer states there is insufficient data to support a dose recommendation. Use in ptn with diabetic kidney disease (off-label use): Dapagliflozin should NOT be started; in ptns previously established on dapagliflozin, some experts continue use off-label with dose of 5 mg once daily (Perkovic 2020).
HF with low EF: no sufficient data to support dose recommendation.
ESRD, HDX: contraindicated. ☝