The National Institute for Health and Care Excellence (NICE) have today issued final draft guidance recommending the use of empagliflozin (Jardiance®) as an option for treating adults with chronic kidney disease (CKD).
It is recommended as an add-on treatment to the highest tolerated dose of converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), where these are suitable, for people have an estimated glomerular filtration rate of:
- 20ml/min/1.73 m2 to less than 45 ml/min/1.73 m2 or
- 45 ml/min/1.73 m2 to 90 ml/min/1.73 m2 and either: a urine albumin-to-creatinine ratio of 22.6 mg/mmol or more, or type 2 diabetes
Empagliflozin is an SLGT2 inhibitor, initially used as a treatment for type 2 diabetes and also approved for heart failure. It is the second medicine of this type to be recommended by NICE as a treatment for people with CKD (the first being dapagliflozin). Research shows that SGLT2 inhibitors can slow down the progression of kidney disease and also reduce the risk of cardiovascular problems, from which people with kidney disease are at much greater risk [1].
Kidney Care UK contributed to the NICE appraisal of this drug, highlighting the challenges of living with kidney disease and the difference a drug that can slow down progress of the disease and potentially delay the need for dialysis can make to people.
Fiona Loud, Policy Director at Kidney Care UK, said: “This is a significant development for people with kidney disease across the UK, particularly the 3.9 million people who are at the earlier stages of CKD. Slowing down kidney disease can be life-changing, particularly if it reduces the chances of someone needing dialysis or a kidney transplant. The availability of this treatment provides even more incentive for monitoring people most at risk of CKD, as it enables diagnosis and appropriate treatment as early as possible.”
The final draft guidance has been sent to all groups involved in the appraisal who have 15 working days to consider whether they wish to appeal against it. Subject to any appeal by consultees, the draft guidance may be used as the basis for NICE's guidance on the use of the treatment in the NHS in England. Final guidance is expected to be published in December 2023.
We recommend you should speak to your clinician if you have any questions about this treatment.
[1] Herrington WG, Staplin N, Wanner C, et al. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388(2):117–127.