Empagliflozin (Jardiance)

Use 10 mg orally each morning for the labeled heart-failure and CKD indications. For glycemic control, start 10 mg daily; 25 mg daily is an option for additional glycemic benefit when 10 mg is tolerated.

Assess kidney function and volume status first. Glycemic use is not recommended below indexed eGFR 30 mL/min/1.73 m2. Heart-failure/CKD evidence includes lower eGFR populations; trials did not enroll patients below 20 or already on dialysis. Trial participants were not required to stop solely upon subsequent decline below 20 or dialysis initiation. This does not establish a dialysis-start regimen. Withhold at least 3 days before surgery or prolonged-fasting procedures when possible.

For adult heart-failure and CKD indications, the label lists 10 mg once daily. The glycemic-control indication is not recommended below eGFR 30 mL/min/1.73 m2; that restriction is not the same as the renal threshold used in heart-failure or CKD trials. Those trials enrolled down to eGFR 20 but did not initially enroll patients below 20 or on dialysis. Trial continuation after renal decline is not proof of eligibility to start on dialysis. The CKD indication excludes specified polycystic-kidney and immunosuppressed populations. Correct volume depletion, assess kidney function and consider ketoacidosis risk. Withhold for at least three days before major surgery or prolonged-fasting procedures when possible; restart when clinically stable and eating. Use the separate pediatric diabetes criteria rather than extrapolating adult cardiorenal indications.

The book lists 10 mg daily at GFR 45-60 mL/min and avoidance below 45. It advises against starting below indexed eGFR 60 and discontinuation for persistent values below 45.

APD/CAPD, HD, high-flux HDF and CAV/VVHD are all marked avoid, with removal considered unlikely. Small pharmacokinetic studies are discussed but do not establish outcome evidence for routine dialysis initiation.