ACUTE AND CHRONIC KIDNEY DISEASE: SGLT2 inhibitors & risk of diabetic ketoacidosis (Sep. 2020) A cohort study from Canad...
ACUTE AND CHRONIC
KIDNEY DISEASE: SGLT2 inhibitors &
risk of diabetic ketoacidosis (Sep. 2020)
A cohort study from
Canada & UK that conducting almost 350,000 ptns in addition to 500 diabetic ketoacidosis
(DKA) events, SGLT2 inhibitors (dapagliflozin (Forxiga), canagliflozin, empagliflozin),
in comparison with dipeptidyl peptidase 4 (DPP-4)
inhibitors, were currently complicated by a higher
risk of DKA (a
reported incidence 2.03 vs 0.75
/1000 person-ys). SGLT2 inhibitors should NOT be used with type 1 DM or with type 2 DM that was
accompanied with factors that enhance the DKA development (e.g., pancreatic
malfunction, drug addiction or alcohol
abuse).
Dose of Dapagliflozin (Forxiga) in adults with Renal
dysfunction:
I. eGFR > 45 mL/minute/1.73 m2: No dosage adjustment
necessary. 😚
II. eGFR 30 - <45 mL/minute/1.73 m2:
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.
III. eGFR <30 mL/minute/1.73 m2:
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.
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