NICE 2025 CKD Update: Dapagliflozin Approved & NHS-Funded for Adults

The National Institute for Health and Care Excellence (NICE) Technology Appraisal Guidance TA1075, published on July 2, 2025, provides evidence-based recommendations on the use of dapagliflozin (Forxiga) for treating chronic kidney disease (CKD) in adults. Below are the key points that primary care clinicians need to know, based on the guidance and relevant evidence, tailored for practical application in primary care settings.

Key Points for Primary Care Clinicians

Who?	Adults with chronic kidney disease (CKD) who: Receive the max-tolerated licensed dose of an ACE-i or ARB (or are contra-indicated) Have eGFR 20–45 ml/min/1.73 m², or eGFR 45–90 ml/min/1.73 m² • with UACR ≥ 22.6 mg/mmol ↑ • or type 2 diabetes
What?	Add dapagliflozin 10 mg once daily to optimised standard care 💊
Choice of SGLT2i	If several SGLT2 inhibitors (e.g. empagliflozin) are suitable, prescribe the least-expensive option ⬇ after discussing pros/cons and considering dosage, administration costs and commercial terms.
Existing NHS patients	Continue dapagliflozin started before this guidance unchanged until patient and clinician decide otherwise ✔
Primary-care take-home	Confirm ACE-i/ARB at max tolerated dose (or contraindicated). Check eGFR and UACR (or T2DM) to confirm eligibility. Discuss alternative SGLT2i and cost before prescribing. Continue existing therapy unless reviewed.

What...

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