Jardiance is FDA-approved for chronic kidney disease (CKD) in adults at risk of progression, with or without diabetes. The EMPA-KIDNEY trial showed Jardiance reduced kidney disease progression or cardiovascular death by about 28 percent. The drug can be initiated down to an eGFR of 20 mL/min/1.73 m² and continued at lower eGFR until dialysis. Benefits include slower kidney function decline, reduced albuminuria, fewer cardiovascular events, and fewer heart failure hospitalizations.
What CKD Means
Chronic kidney disease is defined as abnormal kidney structure or function present for more than 3 months. It is staged by eGFR and albuminuria:
- Stage G1 — eGFR ≥ 90 with kidney damage
- Stage G2 — eGFR 60 to 89 with kidney damage
- Stage G3a — eGFR 45 to 59
- Stage G3b — eGFR 30 to 44
- Stage G4 — eGFR 15 to 29
- Stage G5 — eGFR less than 15, or dialysis
- Albuminuria categories — A1 (under 30 mg/g), A2 (30 to 300 mg/g), A3 (above 300 mg/g)
The EMPA-KIDNEY Trial
| Aspect | EMPA-KIDNEY Details |
|---|---|
| Participants | 6,609 adults with CKD |
| eGFR range | 20 to under 45, or 45 to under 90 with albuminuria |
| Diabetes status | About 46 percent had diabetes |
| Median follow-up | 2.0 years |
| Primary outcome | Kidney disease progression or CV death |
| Result | 28 percent relative risk reduction (HR 0.72) |
| Hospitalization for any cause | 14 percent relative risk reduction |
Mechanism of Kidney Protection
- Reduces glomerular hyperfiltration via afferent arteriolar tone changes
- Lowers intraglomerular pressure
- Decreases albuminuria, which is both a marker and a driver of progression
- Reduces oxidative stress and renal inflammation
- Lowers systemic blood pressure modestly
- Reduces uric acid
- Improves kidney oxygenation through reduced energy demand
- Reduces fibrosis pathways in kidney tissue
Who Should Consider Jardiance for CKD
- Adults with CKD and eGFR 20 to 90 mL/min/1.73 m²
- Albuminuria above 200 mg/g (or 300 mg/g) — strongest indication
- CKD with diabetes — clear benefit
- CKD without diabetes — also benefit per EMPA-KIDNEY
- CKD with concurrent heart failure
- People already on optimal ACE inhibitor or ARB therapy
- Not on dialysis
Who Should Avoid It
- Active dialysis
- Kidney transplant — limited evidence; case-by-case decision
- Type 1 diabetes
- Recurrent genital or urinary infections
- Volume depletion not yet corrected
- Severe acute illness — hold during the episode
- Pregnancy
Dosing for CKD
- 10 mg once daily — only dose for CKD indication
- 25 mg has no additional CKD benefit beyond 10 mg
- Can be initiated at eGFR ≥ 20
- Continued below eGFR 20 until dialysis
- Taken in the morning, with or without food
- No need to time around dialysis (not applicable since contraindicated on dialysis)
What to Expect
| Time Frame | What Typically Happens |
|---|---|
| Week 1 to 4 | Mild initial eGFR drop of 3 to 5; stabilizes |
| Month 1 to 3 | Albuminuria reduction of 20 to 30 percent |
| Month 3 | Blood pressure modestly lower; weight may drop 1 to 3 kg |
| Month 6 | eGFR trajectory shifts to slower decline |
| Year 1 to 2 | Substantial reduction in HF hospitalizations and CV events |
| Long term | Delayed time to dialysis; cumulative survival benefit |
Side Effects in CKD Patients
- Genital yeast infections — similar rate as in non-CKD patients
- UTIs — similar rate
- Volume depletion — higher risk if on loop diuretics; may need diuretic dose reduction
- Acute kidney injury — small initial eGFR drop is expected and reversible; sustained drops require investigation
- Hyperkalemia — actually slightly reduced with SGLT2 inhibitors despite kidney concerns
- Euglycemic DKA — rare; hold for severe illness, surgery, prolonged fasting
Combining with Other CKD Therapies
- ACE inhibitors or ARBs — foundational; SGLT2 inhibitor added on top
- Finerenone (Kerendia) — combine for diabetic kidney disease; additive albuminuria reduction
- Statin — continue per CV risk guidelines
- Loop diuretic — may reduce dose 25 to 50 percent when starting Jardiance
- GLP-1 agonists (Ozempic, Trulicity) — additive benefit in CKD with diabetes
- Sodium bicarbonate — for metabolic acidosis in advanced CKD; no interaction
Monitoring Plan
- Baseline — eGFR, creatinine, urine albumin-creatinine ratio (UACR), potassium, blood pressure, weight, lipid panel
- Week 2 to 4 — eGFR (expect mild drop), potassium
- Month 3 — eGFR, UACR, weight
- Month 6 — full labs as above
- Annual — comprehensive CKD review
- Any acute illness — hold Jardiance, recheck eGFR and ketones if symptomatic
Where Jardiance Fits in Guidelines
The 2024 KDIGO CKD guideline recommends SGLT2 inhibitors as a foundational therapy for adults with CKD and eGFR ≥ 20, with or without diabetes, particularly in those with albuminuria above 200 mg/g. Jardiance and Farxiga are both approved for CKD in the US. The American Diabetes Association similarly endorses SGLT2 inhibitors as preferred therapy for type 2 diabetes with CKD or heart failure.
Related Reading
See our treatment hub, our overview of complications and related conditions, and the related Jardiance for heart failure article. For the trial evidence, see the EMPA-KIDNEY trial in NEJM.
The Bottom Line
Jardiance is FDA-approved for chronic kidney disease in adults at risk of progression, with or without diabetes. The EMPA-KIDNEY trial showed it reduced kidney disease progression or cardiovascular death by about 28 percent. It can be initiated down to an eGFR of 20 mL/min/1.73 m² and continued until dialysis. The dose is 10 mg once daily. Expect a small initial eGFR dip that stabilizes, followed by slower long-term decline. Side effects mirror those in other populations — yeast infections, UTIs, volume depletion, and rare euglycemic DKA. Talk to your doctor about whether Jardiance fits your CKD management plan, especially if you have diabetes, heart failure, or significant albuminuria.
