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Several clinical trials have shown substantial cardiovascular benefits associated with the usage of sodium-glucose cotransporter-2 (SGLT2) inhibitors in individuals diagnosed with chronic kidney disease (CKD) with and without type 2 diabetes (T2D). Recent studies suggest that there is a low use of these therapies in these patients. Still, more data on the real-world prescription and utilization trends of SGLT2 inhibitors needs to be collected. This study aimed to evaluate the rates of usage and variations in primary care practice concerning the utilization of SGLT2 inhibitors among patients with CKD and to evaluate predictors of underuse of these therapies.
Patients above 18 years diagnosed with CKD based on estimated glomerular filtration rate (eGFR) criteria (at least 2 measurements of eGFR 60 mL/min/1.73m2 with a minimum of 3 months) seen by primary care providers between January 01st, 2022 and October 15th, 2023 were included. We included patients with and without type 2 diabetes. Patients with type 1 diabetes, polycystic kidney disease, and initial eGFR below 20 mL/min/1.73m2 were excluded. The study assessed the utilization of SGLT2 inhibitors (empagliflozin, dapagliflozin, and canagliflozin) and analyzed variations in their usage. Evaluation was performed by accessing the medical center's clinical database. We evaluated urine albumin creatinine rate (uACR), cardiovascular risk factors, and clinical and biochemical data. We determined predictors of underuse of SGLT2 inhibitors by calculation of Odds Ratios.
Among 4,800 patients evaluated, we detected 1,062 patients with CKD. Age: 61.1 ± 8.3 years. Female: 472 (44.4%). Diabetes: 254 (23.9%). CKD stage 3a: 504 (47.5%) stage 3b: 478 (45.0%) 4: 80 (7.5%). 690 (64.9%) had at least 1 measurement of uACR. Only 254 (23.9%) were using SGLT2 inhibitors (Table 1). Those receiving SGLT2 inhibitors had higher hemoglobin A1c and blood pressure. Concerning predictors of the use of SGLT2 inhibitors were the presence of diabetes (OR: 6.1 [4.5-8.4]), at least 1 control with a nephrologist (OR: 5.0 [3.6-6.9]) or diabetologist (OR: 25.4 [16.9-37.8]), and at least 1 measurement of uACR (OR: 17.1 [11.9-24.7]), independently of the value of uACR (Figure 1). No age, socioeconomic status, health care system, or cardiovascular risk differences were detected.
The utilization rates of SGLT2 inhibitors remain notably low among patients diagnosed with CKD, with or without T2D. These results suggest that patients who are controlled by physicians with a higher awareness of CKD and performing according to current guidelines are more likely to indicate SGLT2 inhibitors. These findings underscore the potential opportunities to enhance the utilization of SGLT2 inhibitors, especially in the primary care setting, aiming to mitigate future adverse cardiovascular events.
Study supported by FONDECYT Regular 1221571.