SGLT2 inhibitors like Farxiga and Jardiance to slow down CKD

[Mippy13]

Could you share any experience or advice regarding taking SGLT2 inhibitors such as Farxiga or Jardiance. As you may or may not know, these medications have been used for years for diabetes but have more recently been approved to help slow down the progression of kidney disease.

I have read and watched many YouTube videos (by nephrologists) about these medications and the results of the clinical trials that convinced the FDA to fast track their approval. It seems very promising but sometimes you wonder if it’s too good to be true and wonder what you may not know?

We have talked to our nephrologist but he hasn’t offered up much insight. More of a “ I would recommend against it but not provide any reasons behind my opinion” kind of opinion. Not very helpful. And, I wonder if he simply is not very comfortable or knowledgeable since using SGLT2 for CKD is still not a widespread approach.

In addition, it is widely known that your GFR will go down the first few weeks of using an SGLT2 (which feels scary) and if it does, it is not reason to discontinue usage. In fact, research study after research study has shown that the GFR decreases will be in large part be reversed (although not to 100% since it is only meant to slow, not stop, the progression) as long as you continue to take the medication. In the longer term, versus placebo, the studies show that it decreases your GFR decline by 30-40%! Hopefully, keeping you out of the dialysis range.

I share all this because although I am confident that using an Sglt2 inhibitor is a good idea based on my research, I would feel better to hear personal experiences. Has your nephrologist discussed using a SGLT2 with you? What have they said? Have you tried it? Did you have a dip in GFR or any other side effects? Did the dip reverse itself?Does it seem to be working and slowing down the CKD progression?

We are trying to get a second opinion too but that’s a longer story…

Thanks in advance for any insights!

[jodaer]

My doctor started me on Farxiga about a month ago for the reasons you mentioned. I took it for about a week and got excruciating pain in my legs and also was terribly constipated. I tend to be that way anyway but it felt like i had cement in my gut. There is no way I could live like that. And, please no advice on drink more water, Miralax or the like, more fiber (makes it worse) and even my usual remedies didn't work. I'm at the point in my life that living longer but uncomfortably or in pain isn't for me.

[Mippy13 in reply to jodaer]

That’s sounds horrible. I’m so sorry to hear that! Did it get better when you stopped?

Constipation and leg pain are already a problem so I would hate to do anything that might worsen it

Thank you for sharing. This is the kind of stuff you can’t learn from online research.

[jodaer in reply to Mippy13]

I would recommend you try it but first go to Drugs.com and read all about it. Then make your decision. Personally I would not put much faith on anything you just google or watch on U-Tube unless you have vetted them. Just because I had a bad side effect does not mean you will too. Try it, you can always stop it.

[Marvin8]

My nephrologist also panned SGLT-2 inhibitors but wouldn't give a reason. Same goes for Resveratrol and a few other treatments that research studies have shown to be effective. Not to get you too jaded, but....

scientificamerican.com/arti...

[userotc in reply to Marvin8]

Shocking but unfortunately not surprising! My mum's nephro is a kidney transplant surgeon according to my research!

[RoxanneKidney in reply to Marvin8]

OMGOSH THANKS

[Sarah_402]

Hi Mippy13, I had an appointment with my nephrologist this week and he brought up the topic and he sounds like he is for them. I do not have diabetes but he said they are waiting for research to come out about SGLT2s next year and whether or not it’s effective on non diabetics. If it’s effective he said he is going to offer it to me. I have/had acute tubular injury and now CKD. That’s all I know about the subject, I don’t know if his opinion is correct though.

[Mippy13 in reply to Sarah_402]

FYI, the DAPA-CKD study tested Farxiga amongst people with CKD with and without diabetes. Their conclusion was that it was helpful to both groups. Google DAPA-CKD if you want more details.

Thanks so much for your reply.

[Sarah_402 in reply to Mippy13]

Thanks! I’ll check out the study, maybe my doctor is behind

[Bassetmommer NKF Ambassador]

HI Mippy.My husband went on Farxiga this September. He just had labs done last week. His GFR went UP for the first time in a long time. It was 42 in September and was 48 last week. His A1c went down one point but his daily highs and lows are stable. He used to have really big highs and then crash and that is not happening anymore.

I went on a GLPT1 also this fall and..... wait for it....my A1c went from 6.1 to 5.8. My GFR remained the same and I am at a 15. I had to have my PCP prescribe the drugs and now both she and the nephrologists (my husband and I have the same doctors) are amazed at both of us.

Oh and to the constipation: My husband did not have it at all. I did and it lasted for about two months. I used flax seeds in my meals and stool softener and occasional Senekote. Worked fine. But now my body has adjusted, and I am fine without help.

[Mippy13 in reply to Bassetmommer]

That’s amazing. It’s so hard to figure out what to do with this drug because you hear great stories like yours and then other stories that are completely the opposite.

Hope things continue to go well for you and your husband. Please keep us updated if you don’t mind. Thank you!

[jodaer]

Tried those Fatbuddy, didn't work, but thanks

[RoxanneKidney]

My last visit with the neph, she decided against it because the Lisinopril was taking care of the protein issue on its own. I still watch what I eat.

[pigeonman]

I STARTED TAKING FARXIGA IN AUGUST. MY GFR WENT FROM 32 TO 46 CREATNINE DROP 210 TO 1.41. I HOPE YOU CAN TAKE IT.

[Mippy13 in reply to pigeonman]

That’s outstanding! No side effects? Did you have an initial dip in GFR?

Please keep us updated if you don’t mind!

[IgANChris]

My doctor was in favor of trying Farxiga. He even preferred trying that over the recently approved Tarpeyo. I've been on it now for about three weeks. My ACR had been in the 400 to 700 mg range for the most part but then recently just jumped to a little over 2 G. Since I had just gotten my GFR up above 25 to 28 he was able to prescribe it to me. It has since come back down to about 700 MG so I'm not sure how much of that is the Farxiga or if the jump was just an aberration.

Will have to wait and see over a few more months, but I'm not feeling any side-effects.

I'm a stage 4 IgA Nephropathy patient.

[Mippy13 in reply to IgANChris]

Thank you for sharing. It sounds like you have been fortunate and not experienced an initial dip in GFR like many people do.

Good luck and please keep us updated if you don’t mind.

[IgANChris in reply to Mippy13]

I should add that yes, my GFR did drop back down to 24. It may have been the drug or just the fact that that's what my GFR has been bouncing around at lately. That said, a small drop in GFR is often expected when you start taking it which isn't bad when the tradeoff is a drop in proteinuria. It's a better long term tradeoff.

[jodaer]

I've tried all that, they don't work. The only thing that might is TM Smooth Move

[HisLittleOne]

My nephrologist advised not to take unless the GFR is steadily decreasing…said there are too many potentially series side effects from the drug but said he would give it to me if I insisted in trying it—I decided against it since my GFR is hovering around 60 with my diet and Losartan.

[Aloha49]

Are these drugs good for Stage 4 PKD? Anyone experience rise in GFR at stage 4 with them? I do not know if these drugs are as effective for Polycystic disease either. Currently I am focusing on a plant based diet to slow the progression for me, and seeing new nephrologist. Thank you, BB

[Mippy13 in reply to Aloha49]

Farxiga is indicated for folks who have a GFR of 25 or above. I believe the same is true for Jardiance. My understanding is that the threshold exists not because it wouldn’t work below that but rather because that was what was tested in the clinical study (DAPA-CKD) and proven to be beneficial. The key is if you want to try it you have to initiate it while your GFR is above 25 otherwise, your doctor will not prescribe it.

Note, there was another study that was more recently completed (EMPA- kidney) that tested patients with GFR is as low as 20.

Hope that helps and best of luck.

[Autumncolor]

My husband had a GFR of 24 in mid July 2021 when his nephrologist prescribed Jardiance, for all the reasons you described. His GFR has steadily declined ever since. His GFR is currently 11 and he's being told he will need dialysis by late Spring if his numbers don't improve. We're both very upset this drug was prescribed. It has hastened his path to dialysis, which ironically, is what this drug is advertised to help with.

[Mippy13]

Thank you for sharing. I’m so sorry to hear about this. These are the stories that make me afraid to try it. Did your doctor have any explanation for the unexpected results? Is there anything as far as you know that made him a higher risk for this type of thing?

Perhaps this is the expected initial dip and hopefully it will reverse itself? I read a study that said that in patients >=65 (not sure how old your husband is), the initial reduction in GFR was of a similar magnitude to younger patients however, recovery of GFR appeared slower but were stable up to 102 weeks.

I hope it turns around for your husband.

The name of the study is “Long term safety of dapagliflozin in older patients with type 2 diabetes mellitus” if you want to read more about it. Note, this study was not conducted specifically with people with CKD.

Please keep us updated if you don’t mind.

[pigeonman]

I STARTED FARXIGA. IN MID AUGUST. MY DR DID NOT OFFER IT UNTIL I ASK FOR IT. I HAVE NO SIDE EFFECTS SO FAR. MY GFR WAS 32 SEPT. IT WAS 46 IN NOV. I FIGURED THE TEST WAS WRONG. MY CREATINE WAS 210 IN AUGUST NOW IT DROPPED TO 141.I HOPE IT MAINTANS.

[itzmich]

I've been on Farxgia since June of 2021. No side effects at all. My gfr went up a little from 30 to 35. Sorry you are having side effects. I do drink lots of water and eat a high fiber diet. If my gfr just remains the same I feel happy with that.

[Sophiebun11]

This sounds promising and I truly hope it helps for millions of CKDers. My Neph will only offer me Prednisone or CellCept as I have autoimmune kidney damage which is different.

It is exciting new none the less. Thanks for posting

[Turtlepad513]

I tried both. Farxiga gave me extreme fatigue and Jardiance killed my GFR to 15 within 2 months. Was taken off them.