Real-World Use of SGLT2 Inhibitors in Patients with CKD with and without Diabetes: A Population-Based Cohort Study

Background: Several studies have revealed cardiovascular and renal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in chronic kidney disease (CKD). Recent studies indicate that SGLT2i are underutilized in real-world situations. This study aimed to assess the usage rates in primary care practices regarding SGLT2i use among CKD patients. Methods: Observational study of CKD patients > 18 years (eGFR < 60 mL/min/1.73m2) in medical control in primary care facilities between January 2022 and December 2023. We included both patients with and without type 2 diabetes. We excluded patients with type 1 diabetes, polycystic kidney disease, and an initial eGFR < 20 mL/min/1.73m2. The study assessed the use of SGLT2i and analyzed variations in their usage through multivariate analysis. Results: 1,062 patients were included in the study. Age: 61.1±8.3 years. Female: 472 (44.4%). Diabetes: 254 (23.9%). CKD G3a: 504 (47.5%), G3b: 478 (45.0%), G4: 80 (7.5%). 690 (64.9%) had at least one urine albumin-to-creatinine ratio (uACR) measurement. Only 254 (23.9%) were using SGLT2i. Predictors of SGLT2i use included the presence of diabetes (OR: 6.1 [4.5-8.4]), at least one consultation with a nephrologist (OR: 5.0 [3.6-6.9]) or diabetologist (OR: 25.4 [16.9-37.8]), and at least one uACR measurement (OR: 17.1 [11.9-24.7]), regardless of the value (Figure 1). No significant differences were found in age, socioeconomic status, healthcare system, or cardiovascular risk factors. Conclusion: The utilization rates of SGLT2i are notably low among CKD patients. The results suggest that patients managed by physicians who are more knowledgeable about current CKD guidelines are more likely to receive SGLT2i. These findings highlight significant opportunities to improve the use of SGLT2i, particularly in primary care settings, to prevent future adverse clinical outcomes. Study supported by FONDECYT Regular 1221571. Funding: Government Support – Non-U.S.