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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is), initially approved for treatment of hypoglycaemia in patients with type 2 diabetes, are now recommended in clinical guidelines for patients with chronic kidney disease (CKD) with and without diabetes, based on evidence of renal and cardiovascular benefits. However, recent real-world evidence has revealed that adherence to SGLT2is is poor. This targeted literature review aimed to investigate CKD patient adherence to SGLT2is and relevant treatment guidelines, and examined impacts on clinical, safety, quality of life (QoL), and economic outcomes.
Searches of Embase, MEDLINE®, and The Cochrane Library electronic databases were conducted on 20 May 2025, restricted to English-language publications published from 2020–2025. Eligible publications were screened for data on SGLT2i adherence rates in patients with CKD and factors influencing adherence. Twenty articles were identified as relevant for inclusion.
Across included studies, adherence rates to SGLT2is ranged from 51% to 92%. Patient data from Denmark, The Netherlands, Spain, Japan, the United States, and China demonstrated that SGLT2i use decreased over time; on average, the largest proportional decrease occurred between day 90 and day 180 after treatment initiation, with SGLT2i use reducing by approximately 10% between these time points. Patient-level factors associated with adherence included gender, race, comorbidities, diabetic complications, polypharmacy, and frailty. One study found that patient education integrated with medication management improved adherence. Five studies examined physician adherence to diabetes/CKD guidelines, with adherence ranging between 8.8–97.9% and 66% of physicians considered international guidelines as fundamental to their practice. Adherence rates varied by physician specialty and international guideline type. In surveyed cohorts, physicians identified that barriers to guideline adherence included reimbursement issues, prioritization of local guidelines, and reliance on individual judgement/institutional protocols, and factors that could facilitate adherence were alignment of reimbursement policy with guidelines, simplification of guideline content, and translation into local languages. SGLT2i discontinuation was correlated with increased risk of all-cause death (HR 1.57 [95% CI: 1.49, 1.66]; p<0.0001), and low adherence was linked to poorer glycaemic control. US claims data showed that higher insurance coverage correlated with better adherence, while patients with low adherence were more likely to have federally funded insurance compared with high adherence cohorts (12% vs 4%). No data were identified regarding adherence impact on QoL or safety outcomes.
Adherence to SGLT2is in CKD management is poor and is associated with increased mortality risk and reduced glycaemic control. Addressing patient-level and system-level barriers to adherence may represent potential avenues for improving CKD management and patient outcomes. Further research is warranted to evaluate the impact of targeted interventions on patient outcomes and healthcare utilization.
