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The approval of dapagliflozin for the treatment of CKD was a significant advancement in CKD Dapagliflozin provides a once daily oral treatment for patients with CKD.
CKD leads to a gradual loss of kidney function, and can influence the progression of type 2 diabetes (T2D) and heart failure (HF), worsening overall prognosis3-7
people were living with CKD in the United Kingdom (UK) in 20228
premature deaths occur every year in individuals with CKD in the UK3
is the estimated cost of kidney disease to the NHS in 20238
of all CKD-related hospitalisations are accounted for by frequently-hospitalised non-dialysis patients, of which most cases are attributed to HF and hyperkalemia9
is the extra number of patients requiring dialysis in 2033, which is a growth rate of 375% on 2023 (30,000)10
is the estimated cost to the NHS for one patient on dialysis per year10
unplanned hospital admissions occur annually per 100 patients with Stage 4 vs. Stage 3 CKD11
patients die annually per 100 patients with Stage 4 vs. Stage 3 CKD11
Dapagliflozin can be used as an option to treat chronic kidney disease (CKD) in adults, if:
For people with CKD12
UKKA recommend initiating SGLT-2 inhibition in people with chronic kidney disease, irrespective of primary kidney disease,* for any of the following clinical scenarios (Grade 1A):
a. eGFR of ≥20 mL/min/1.73m2 and a urinary albumin-to-creatinine ratio (uACR) of ≥25 mg/mmol†
b. Symptomatic heart failure, irrespective of ejection fraction
*excludes people with polycystic kidney disease, type 1 diabetes, or a kidney transplant
†urinary protein-to-creatinine ratio of 35 mg/mmol can be considered equivalent
UKKA recommend initiating SGLT-2 inhibition to slow rate of kidney function decline in people with an eGFR of 20-45 mL/min/1.73m2 and a uACR of <25 mg/mmol* (Grade 1B)
*urinary protein-to-creatinine ratio of 35 mg/mmol can be considered equivalent
UKKA suggest clinicians consider initiating SGLT-2 inhibition in people with an eGFR below 20 mL/min/1.73m2 to slow progression of kidney disease (Grade 2B)**
**There is limited experience with initiating FORXIGA (dapagliflozin) treatment in patients with eGFR <25 mL/min/1.73m2, and no experience in patients with eGFR <15 mL/min/1.73m2. Therefore, it is not recommended to initiate treatment in patients with eGFR <15 mL/min/1.73m2
For people with CKD and T2D12
Due to the benefits of SGLT-2 inhibitors on kidney outcomes (CKD and AKI) and cardiovascular risk:
UKKA recommend initiating an SGLT2 inhibitor in people with chronic kidney disease and type 2 diabetes, irrespective of primary kidney disease,* for any of the following 4 clinical scenarios (Grade 1A):
(a) eGFR of 20-45 mL/min/1.73m2
(b) eGFR of >45 mL/min/1.73m2 and a urinary albumin-to-creatinine ratio (uACR) of ≥25 mg/mmol†
(c) Symptomatic heart failure, irrespective of ejection fraction
(d) Established coronary disease
*excludes people with polycystic kidney disease, type 1 diabetes, or a kidney transplant
†urinary protein-to-creatinine ratio of 35 mg/mmol can be considered equivalent
UKKA suggest initiating SGLT-2 inhibition to modify cardiovascular risk and slow rate of kidney function decline in people with an eGFR >45-60 mL/min/1.73m2 and a uACR of <25 mg/mmol, recognising effects on glycaemic control will be limited (Grade 2B)
UKKA suggest clinicians consider initiating SGLT-2 inhibition in people with an eGFR below 20 mL/min/1.73m2 to slow progression of kidney disease (Grade 2B)**
**There is limited experience with initiating FORXIGA (dapagliflozin) treatment in patients with eGFR <25 mL/min/1.73m2, and no experience in patients with eGFR <15 mL/min/1.73m2. Therefore, it is not recommended to initiate treatment in patients with eGFR <15 mL/min/1.73m2
Current NICE guidelines include recommendations for multifactional interventional approaches for the management of CKD (NG203; Chronic kidney disease: assessment and management) and associated comorbidities, such as diabetes (NG28; Type 2 diabetes in adults: management), hypertension, heart failure (HF) (TA679; Dapagliflozin for treating chronic heart failure with reduced ejection fraction; TA902; Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction), and dyslipidaemia13–15
Along with UKKA, ABCD recommend using an SGLT2i in all patients with CKD in T2D eGFR >15ml/min/1.73m2 16
DAPA-CKD was a landmark study that investigated the use of dapagliflozin in the treatment of chronic kidney disease (CKD) patients, with or without type 2 diabetes (T2D)2
*This list is not exhaustive, please refer to the supplementary appendix for the full list of key exclusion criteria2
DAPA-CKD was a landmark study that investigated the use of dapagliflozin in the treatment of chronic kidney disease (CKD) patients, with or without type 2 diabetes (T2D)2
Dapagliflozin reduces the risk of the composite of declining kidney function, ESKD and renal or CV death on top of standard of care compared with placebo2,17
Prespecified analysis: There were fewer events of declining kidney function, ESKD, and renal or CV death with dapagliflozin 10 mg compared with placebo2
Adapted from McMurray et al. 2021
Adapted from Heerspink et al. 2020
in all-cause mortality vs. placebo1
(4.7% vs. 6.8%) HR 0.69; 95% CI, 0.53, 0.88; p=0.004.
in the composite of CV death or hospitalisation for heart failure (hHF) vs. placebo, driven by hHF1
(4.6% vs. 6.4%) HR 0.71; 95% CI, 0.55, 0.92; p=0.009.
Understand key safety considerations about the use of dapagliflozin.
Dapagliflozin offers simple, once daily dosing of 10mg9 across the range of eGFR.
In patients with severe hepatic impairment, a starting dose of 5 mg is recommended. If well tolerated, the dose may be increased to 10 mg.
There is limited experience with initiating dapagliflozin treatment in patients with eGFR <25 mL/min/1.73m2, and no experience in patients with eGFR <15 mL/min/1.73m2. Therefore, it is not recommended to initiate treatment in patients with eGFR <15 mL/min/1.73m2
ABCD, Association of British Clinical Diabetologists; ACEi, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; ARR, absolute risk reduction; CKD, chronic kidney disease; CV, cardiovascular; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; GFR, glomerular filtration rate; HF, heart failure; HR, hazard ratio; NICE, National Institute for Health and Care Excellence; NNT, number needed to treat; RRR, relative risk reduction; SGLT2i, Sodium/glucose cotransporter-2 inhibitors; SoC, standard of care; T2D, type 2 diabetes; uACR, urine albumin-creatinine ratio; UK, United Kingdom; UKKA, UK kidney association.
GB-70106 | September 2025
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