Scope of this summary
Adults with CKD at risk of progression being considered for dapagliflozin under current US labeling, with or without type 2 diabetes as the label permits. This page does not cover type 1 diabetes, diabetic ketoacidosis treatment, dialysis or a complete heart-failure regimen.
The Bottom Line
- The US Farxiga label includes adults with CKD at risk of progression to reduce sustained eGFR decline, end-stage kidney disease, cardiovascular death and hospitalization for heart failure.
- Confirm the labeled population and recognize label limitations for polycystic kidney disease or recent kidney-disease immunosuppression rather than treating every low eGFR as the same indication.
- Assess renal function and volume before starting, correct clinically important depletion, and use the current label for initiation and continuation at low eGFR.
- Explain that a small early eGFR change can be hemodynamic, while a large or progressive decline, hypotension or acute illness requires reassessment of volume, medicines and competing causes.
- Continue broader CKD treatment, including blood-pressure, renin-angiotensin-system, diabetes, lipid and albuminuria care; dapagliflozin is additive rather than a substitute.
Practical clinical workflow
1
Confirm chronicity, progression risk and indication; check eGFR, volume, blood pressure, glucose and recent ketosis, infection, fasting or surgery, and reconcile diuretic and insulin therapy.
2
Start the FDA-labeled dose, counsel on genital and urinary symptoms, hydration, sick-day interruption and ketoacidosis symptoms, and arrange renal and clinical follow-up.
3
Review blood pressure, volume, kidney function and glycemia after initiation according to risk; adjust diuretic or glucose-lowering therapy when physiology, not a routine rule, supports it.
4
Withhold for at least the label-specified interval before major surgery or prolonged fasting and restart only when clinically stable and oral intake has resumed.
5
During acute illness, evaluate ketones when symptoms suggest ketoacidosis even if glucose is not markedly elevated, and investigate a major renal change rather than assuming an expected dip.
Safety boundaries and escalation
- Do not use Farxiga to improve glycemic control in type 1 diabetes; SGLT2 inhibition can cause life-threatening ketoacidosis with less prominent hyperglycemia.
- Stop and urgently assess nausea, vomiting, abdominal pain, malaise or dyspnea with possible ketoacidosis; address insulin reduction, fasting, alcohol, dehydration and illness triggers.
- Evaluate urosepsis, pyelonephritis, genital mycotic infection and rare perineal necrotizing fasciitis promptly, and monitor hypotension or acute kidney injury in volume-vulnerable patients.
- Pregnancy, dialysis, severe acute illness and an interacting diuretic or insulin plan require current label and specialist review rather than automatic continuation.
sources for this section:FDA Farxiga label
Localization
US payer documentation may ask for eGFR or albuminuria, but clinical eligibility and safe dosing come from the label and current guideline.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- U.S. Food and Drug AdministrationFARXIGA (dapagliflozin) tablets, current US prescribing informationDrugs@FDA application 202293; current label checked 2026-08-20 · accessed 2026-08-20view source
- Kidney Disease: Improving Global OutcomesKDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney DiseaseDOI 10.1016/j.kint.2023.10.018 · published 2024-03-13 · accessed 2026-08-20view source
- American Diabetes Association Professional Practice Committee for DiabetesStandards of Care in Diabetes—20262026 Standards of Care, including living online updates · published 2025-12-08 · accessed 2026-08-20view source
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