Patient-Level Factors Associated with the Prescription of SGLT2 Inhibitors in Patients with CKD

Background: Sodium/glucose cotransporter 2 inhibitors (SGLT2i) are a valuable therapy in patients with chronic kidney disease (CKD). However, since approval by the Food and Drug Administration, they have not gained widespread use in CKD patients. In this study, we aimed to evaluate the patient-level factors associated with SGLT2i prescription within the Yale New Haven Health System. Methods: This is a retrospective study of patients with CKD and eGFR ≥20mL/min/1.73m2, treated in the inpatient or outpatient setting from 2021 to 2024. We used a multivariable logistic regression model to estimate the adjusted odds ratios (aOR) to identify factors associated with SGLT2i perscription. We adjusted for sociodemographic and clinical factors. Results: Out of a total of 352,408 eligible patients with CKD, 5,728 (1.6%) were prescribed SGLT2i. Patients who received a prescription were more likely older (median (IQR) 70 (60-78) vs. 62 (48-73) years, p<0.001), male (61% vs. 42%, p<0.001), Black (19% vs.12%, p<0.001) and retired (50% vs. 33%, p<0.001) as compared to those who did not receive an SGLT2i. The most frequent specialties prescribing SGLT2is were Internal Medicine (35%) and Cardiology (31%), with only 3% of perscriptions by Endocrinologists and 1% by Nephrologists. Among Hispanic and Black CKD patients, only 1% and 2% respectively were prescribed SGLT2is. Native American (aOR 0.36, 95%CI 0.26-0.52), Black (aOR 0.49, 95%CI 0.45-0.52), and Asian (aOR 0.62, 95%CI 0.52-0.73) patients were 64%, 51%, and 38% less likely to get prescribed SGLT2is as compared to White CKD patients, respectively. Similarly, patients with Medicaid (OR 0.81, 95%CI 0.75-0.88) were 19% less likely to be perscribed as compared to the ones with comercial insurance. Patients unable to work due to disability (OR 0.36, 95%CI 0.33-0.40) and unemployed (OR 0.62, 95%CI 0.57-0.68) were also 64% and 38% less likely to be prescribed an SGLT2i, respectively, when compared with employed patients. Conclusion: In this preliminary analysis of patient-level factors, we found that there is suboptimal use of SGLT2is in the CKD population and that social determinants of health impact the prescription of these medications. There is a need for further evaluation of interventions to promote the use of SGLT2is in CKD patients with emphasis on health equity for all.