How does Farxiga help kidneys?

Kidney disease is much more common than some may realize. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 7 U.S. adults have chronic kidney disease, and 90% do not know that they have it. Luckily, we are gaining tools to help damaged kidneys, and Farxiga (dapagliflozin) is one of the medications in our toolbox now. As a sodium-glucose cotransporter 2 (SGLT2) inhibitor, it can help to lower the strain on renal blood vessels, slowing the progression of kidney disease. Although its original indication from the Food and Drug Administration (FDA) was for treating Type 2 diabetes mellitus, the drug is now approved for use in reducing the risk of progression of chronic kidney disease (CKD), even for those without diabetes. Here’s how it works.

RELATED: What is Farxiga used for?

Farxiga and kidney disease

When blood flows into the kidneys, it enters a network of progressively smaller blood vessels until it reaches the microscopic glomeruli—the filtration units. Within a glomerulus, certain components of blood are filtered out, with some added back into the blood later in order to form urine. Also passing through the filters is a portion of water, electrolytes like sodium, and glucose (sugar). Glucose is usually all reabsorbed back into the blood later in the glomerular network unless glucose levels are high. Ultimately, blood flows out through renal veins into our circulation and the urine that was created flows to the bladder.

Each kidney harbors half a million glomeruli, and these delicate capillary structures can be damaged. The damage can be done gradually, as in the cases of damage from hypertension and diabetes mellitus. It can also occur more rapidly, such as with sepsis-induced hypotension (low blood pressure), immune disease like glomerulonephritis, or medications like excessive nonsteroidal anti-inflammatory drugs (NSAIDs). When damaged for any reason, the filtration units may not eliminate toxins as well, balance electrolytes as finely, or keep proteins in the blood as they should.

The effect of Farxiga on kidney function

Farxiga and other SGLT2 inhibitors like Jardiance (empagliflozin) and Invokana (canagliflozin) block glomerular reabsorption of glucose into the bloodstream. As a result, glucose spills into the urine, and blood glucose levels are lowered. Less sodium is reabsorbed as well, leading to sodium and water loss into the urine. This results in lower blood pressure systemically. Locally, in the glomerulus, blood pressure is reduced in the tiny vessels as well. This reduces strain on the filtration units and preserves kidney function.

In a clinical study of over 4,000 CKD patients with excess protein in the urine, Farxiga reduced the risk of progression of kidney failure. These benefits were seen in patients with diabetes and patients without diabetes. Even those with severe renal disease experienced a benefit, according to an additional analysis. Bolstering the evidence behind SGLT2 inhibitor use for CKD is a meta-analysis of trials involving over 90,000 patients that supported this use.

Managing kidney complications in diabetes with Farxiga

Diabetes is the most common cause of kidney disease. Nationally, of all patients with end-stage renal disease (ESRD), which is the stage at which dialysis is required, 60% have diabetes. Kidney health must be a major focus of diabetes management as any chance to slow disease progression could be a way to avoid dialysis.

Controlling blood pressure and blood glucose can preserve renal function. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are two antihypertensive classes of drugs that have proven their worth in this regard for years. 

Now, SGLT2 inhibitors are used as well, even if additional glucose-lowering is not required. Farxiga is used in the setting of Type 2 diabetes with diabetic kidney disease, particularly in patients with excess protein in the urine, so-called proteinuria or albuminuria. Farxiga can also reduce congestive heart failure risks too. 

Understanding potential side effects of Farxiga

Although there are advantages to using Faxiga for CKD, it’s important to understand its adverse effects as well. For example, by increasing urinary glucose content, the drug can lead to urinary tract infections and genital yeast infections—two of the most common side effects of Farxiga. 

More serious side effects can occur as well, beyond serious urinary tract infections. Losing water and salt into the urine as a result of taking Fariga could lead to lower blood volume and orthostatic hypotension, which is a drop in blood pressure when standing. Worse yet, the drop in blood pressure could lead to acute kidney injury or jeopardize circulation elsewhere, creating a risk of gangrene. Warnings about Farxiga also include diabetic ketoacidosis, which can occur from a reduction in insulin secretion from the pancreas.

Farxiga dosage for chronic kidney disease

Farxiga is taken as a 10-milligram (mg) tablet once daily when prescribed to reduce the risk of disease progression in CKD. This is a little different from the Farxiga dosage for Type 2 diabetes mellitus alone, which starts at 5 mg daily and can increase to 10 mg daily if needed. In either circumstance, dosing the drug in the morning can be best in order to reduce urination through the night. Blood pressure, blood sugar, kidney function, and electrolyte levels are typically monitored during therapy with Farxiga.

Cost can be a significant hurdle to getting Farxiga for any indication because there is no generic form available. A SingleCare prescription discount card can provide access to Farxiga coupons that can help you save. With a SingleCare Farxiga coupon, you could pay $366.85 instead of the typical retail price of $800.29 for 30, 10 mg tablets.

How to use Farxiga safely for kidney health

Great benefits and serious risks surround Farxiga use for kidney health. Choosing who should take it is not easy. If kidney disease is too advanced, Farxiga may have too much risk of kidney function decline. If there is no proteinuria–elevated protein levels in the urine—with renal impairment, benefits may not be as substantial. Interactions with other drugs or health conditions may mean that you need to stay clear or be extra cautious of an SGLT2 inhibitor. Only a healthcare provider can decide whether Farxiga is right for you, but knowledge about the drug can aid your discussion.