Dapagliflozin (CKD Indication)

How it works

By inhibiting sodium-glucose co-transporter 2 in the proximal tubule it increases sodium delivery to the macula densa; the resulting tubuloglomerular feedback lowers intraglomerular pressure, which underlies its renoprotective effect.

Prescribing in practice

• Expect a small, reversible fall in eGFR when starting (a haemodynamic effect, not harm) — do not stop for this alone; euglycaemic diabetic ketoacidosis can occur, so advise sick-day rules and withhold during acute illness.
• Genital fungal infections and volume depletion occur; there is a lower eGFR limit below which initiation is not recommended (check current prescribing references).
• It is not for type 1 diabetes; rare necrotising fasciitis of the perineum (Fournier's gangrene) is reported.

Monitoring

Monitor renal function (anticipating the initial eGFR dip), volume status and blood pressure; check ketones if the patient is unwell, regardless of glucose.

Counselling the patient

• Keep taking it despite a small early change in your kidney blood tests — this is expected.
• Pause it during acute illness, vomiting or dehydration and seek advice (sick-day rules).
• Report genital itching or discharge, or severe pain/swelling around the genitals or perineum.

Evidence & guidelines

Slows CKD progression and reduces cardiorenal and mortality outcomes with or without diabetes (DAPA-CKD; NICE TA775).