Jardiance (empagliflozin) is one of the strongest medications available for protecting kidney function. In the largest trial studying its effects on kidneys, it reduced the risk of kidney disease progression by 29% compared to a placebo. The FDA approved it in 2023 specifically to slow chronic kidney disease in adults at risk of progression, making it one of a small number of drugs with this indication.
How Jardiance Protects the Kidneys
Jardiance belongs to a class of drugs called SGLT2 inhibitors, which were originally designed to lower blood sugar by blocking sugar reabsorption in the kidneys. But their kidney benefits go well beyond blood sugar control.
In diabetes and chronic kidney disease, the tiny filtering units in your kidneys (called glomeruli) are forced to work under higher-than-normal pressure. Over time, this excess pressure damages the filters and accelerates kidney decline. Jardiance reduces that pressure through a surprisingly elegant mechanism: it changes how much sodium reaches a pressure-sensing structure near each filter. When more sodium arrives at this sensor, it triggers the blood vessel feeding into the filter to constrict slightly, easing the pressure inside. This process is driven by a signaling molecule called adenosine. In animal studies, blocking adenosine receptors completely eliminated the drug’s ability to reduce hyperfiltration, confirming this is the primary pathway.
The result is that each filtering unit handles a more sustainable workload, which slows the progressive scarring that leads to kidney failure.
What the Major Trials Found
The landmark EMPA-KIDNEY trial enrolled over 6,600 adults with chronic kidney disease. Kidney disease progression occurred in 11.6% of patients taking Jardiance versus 15.2% of those on placebo, a 29% relative risk reduction. The trial’s primary outcome combined kidney disease progression with cardiovascular death, and Jardiance’s benefit came mainly from slowing kidney decline rather than preventing heart-related deaths.
A separate trial in heart failure patients (EMPEROR-Reduced) looked at a composite kidney outcome that included severe kidney function decline, the need for dialysis, or kidney transplant. Jardiance cut this risk by roughly 50%, and the benefit held whether or not patients had pre-existing chronic kidney disease.
Benefits Even Without Diabetes
One of the most important findings is that Jardiance protects kidneys regardless of whether you have diabetes. A large meta-analysis pooling data from 13 trials and more than 90,000 patients found that SGLT2 inhibitors reduced the risk of kidney disease progression by 37%, with nearly identical benefits in people with and without diabetes. The EMPA-KIDNEY trial specifically included nondiabetic participants and confirmed the benefit across this broader population.
This was a meaningful shift. For years, kidney-protective drugs in this class were viewed primarily as diabetes medications with a nice side benefit. The evidence now supports their use as kidney drugs in their own right.
Who Can Take Jardiance for Kidney Protection
The FDA approval covers adults with chronic kidney disease at risk of progression. In the EMPA-KIDNEY trial, this included patients with an eGFR (a measure of kidney filtering capacity) as low as 20, or those with an eGFR between 45 and 90 who also had significant protein in their urine.
There are some exclusions. Jardiance is not recommended for kidney protection in people with polycystic kidney disease or those who are on or recently received certain immunosuppressive therapies for kidney disease. Your kidney function will be checked before starting the medication, and periodically afterward.
The Initial Kidney Function “Dip”
If you start Jardiance and get blood work done in the first few weeks, you may see your eGFR drop. This can be alarming, but it’s expected and generally not a sign of harm. In one major trial, the median eGFR reduction at four weeks was about 2.7 points, and roughly 28% of patients saw a dip greater than 10%. Across studies of SGLT2 inhibitors, the typical population-wide dip is a modest 3 to 5 points.
This dip reflects the drug doing exactly what it’s supposed to do: reducing the excess pressure inside your kidney filters. Lower pressure means a temporarily lower filtration rate on paper, but it’s actually protecting the filters from long-term damage. Think of it like easing off a car’s accelerator. The engine produces less power in the short term, but it lasts much longer. In clinical trials, patients who experienced this early dip went on to have better long-term kidney outcomes than those on placebo, and the dip typically stabilized within the first month.
Side Effects to Watch For
Jardiance is generally well tolerated, but it carries some risks worth knowing about. Because the drug works by pushing more sugar into your urine, it creates an environment where yeast and bacteria can thrive. Genital yeast infections are the most common side effect, particularly in women. Urinary tract infections also occur more frequently.
A rare but serious risk is a condition called Fournier’s gangrene, a rapidly spreading soft-tissue infection in the genital or perineal area. As of late 2025, 44 cases had been reported worldwide in patients taking Jardiance across all its uses, including 3 fatal cases. While extremely uncommon, any pain, swelling, redness, or tenderness in the genital area, especially with fever, should be evaluated immediately.
Dehydration and low blood pressure can also occur, since the drug increases urination. This is more relevant for older adults or those already taking blood pressure medications. Staying well hydrated and being aware of dizziness when standing up are practical steps to manage this.
How It Fits Into Kidney Disease Treatment
Jardiance is taken as a single daily pill, typically in the morning. For kidney protection, it works alongside other foundational treatments like blood pressure control and, when appropriate, medications that block the renin-angiotensin system. It doesn’t replace these therapies but adds a distinct layer of protection through a different mechanism.
The strength of the evidence has made SGLT2 inhibitors, including Jardiance, a standard part of chronic kidney disease management in current clinical guidelines. For many people with CKD, adding this medication represents one of the most impactful steps available to slow the progression toward dialysis or transplant.