Pharmacists in nephrology clinics improve empagliflozin use in diabetic kidney disease patients

Inclusion of clinical pharmacists within an interprofessional nephrology clinic for the initiation and monitoring of empagliflozin in diabetic kidney disease (DKD) patients produces clinical benefits with minimal safety concerns, a recent study has shown.

The authors evaluated the safety and efficacy of an interprofessional clinic model that partnered nephrologists and pharmacists for the initiation and monitoring of sodium-glucose cotransporter-2 (SGLT2) inhibitors. The role of the clinical pharmacist was to provide patient education, telephone follow-up, and to work collaboratively with nephrologists.

Following initiation of empagliflozin, diabetes, hypertension, and diuretic regimens were adjusted as needed. Diabetes treatment was also adjusted to adhere to the 2019 American Diabetes Association (ADA) guidelines promoting agents with chronic kidney disease (CKD) and atherosclerotic cardiovascular disease benefit.

Fourteen patients started treatment with empagliflozin during the study period. Urine albumin-to-creatinine ratio (UACR) showed improvement, with a mean percentage change of –12±61 percent. Patients with a higher baseline UACR had greater mean percentage change. The mean change in glycated haemoglobin was 0.3±0.6 percent.

Common adverse reactions occurred, but they all improved over time. Serious adverse drug reactions did not occur.

Notably, almost all patients (n=13, 93 percent) initiated on empagliflozin needed adjustments to diabetes, hypertension, and diuretic regimens.

“The ADA recommends SGLT2 inhibitors as the second medication to be started, after metformin, for patients with CKD,” authors said. “SGLT2 inhibitors may cause volume, blood pressure, and electrolyte disturbances; consequently, frequent monitoring and adjustments to other diabetes, blood pressure, and/or diuretic medications may be necessary.”