Empagliflozin (CKD Indication)

How it works

It blocks the sodium-glucose co-transporter 2 in the proximal tubule, reducing glucose reabsorption and, via tubuloglomerular feedback, lowering intraglomerular pressure and albuminuria to confer nephroprotection.

Prescribing in practice

• Anticipate and counsel on a small, reversible 'dip' in eGFR after initiation, which is expected and not a reason to stop; the long-term trajectory is preserved kidney function.
• There is a lower eGFR threshold below which initiation is not recommended, so confirm renal function against the current SPC before starting.
• Hold during acute illness, dehydration or perioperative fasting (sick-day rules) because of the risk of volume depletion and euglycaemic diabetic ketoacidosis.

Monitoring

Check renal function and volume status before starting and periodically thereafter, recognising the expected early eGFR reduction.

Counselling the patient

• Pause the tablet if you become acutely unwell, dehydrated or are unable to eat or drink normally.
• Maintain good genital hygiene as fungal infections can occur, and report any genital pain or swelling promptly.
• Do not stop it just because a blood test shows a small fall in kidney readings soon after starting.

Evidence & guidelines

The EMPA-KIDNEY trial demonstrated reduced progression of kidney disease and cardiovascular death across diabetic and non-diabetic CKD, supporting NICE-endorsed use.