Trends in Utilization of Guideline-Directed Cardiorenal Protective Therapies for Chronic Kidney Disease in Patients with Cardiovascular Morbidity: Real World Data from Two Cross-Sectional Snapshots (HECMOS I and II)
<b>Introduction:</b> Chronic kidney disease (CKD) affects roughly 10% of the global population and significantly increases cardiovascular risk. While renin-angiotensin system inhibitors (RASi) remain a therapeutic mainstay, recent evidence supports the renoprotective value of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and finerenone. This study evaluated the real-world use of guideline-directed medical therapy (GDMT) among patients with cardiorenal disease in Greece and explored factors influencing prescribing patterns. <b>Methods:</b> The Hellenic Cardiorenal Morbidity Snapshots (HECMOS 1 and 2) enrolled all cardiology inpatients across Greece on 3 March, 2022, and 5 June, 2024. Comorbidities and medication data were based on self-report and chart review. CKD patients eligible for SGLT2i and finerenone were identified per guideline criteria. Multivariable logistic regression was used to identify predictors of SGLT2i use. <b>Results:</b> From a total of 923 and 1222 patients enrolled in HECMOS 1 and 2, CKD was present in 26% and 27%, respectively. SGLT2i use prior to hospitalization rose from 15% in HECMOS 1 to 30.4% in HECMOS 2. In HECMOS 1, diabetes mellitus was the strongest predictor of SGLT2i use (OR 12.01, 95% CI 3.31-45.56, <i>p</i> < 0.001), while heart failure predicted use in HECMOS 2 (OR 4.10, 95% CI 1.70-9.88, <i>p</i> = 0.002). Finerenone was prescribed in only 1.7% of eligible patients in HECMOS 2. RASi usage among CKD patients remained stable across both cohorts (42.1% vs. 41.7%), with renal dysfunction showing no impact on prescribing patterns. <b>Conclusions:</b> SGLT2i use in patients with CKD and cardiovascular disease doubled over 2 years, indicating progress in implementing GDMT. However, overall use of disease-modifying therapies remains suboptimal, underscoring the need for further improvement in real-world care.
Authors
- Nikolaos Patsourakos (ORCID: https://orcid.org/0000-0001-5198-6314)
- Matthaios Didagelos (ORCID: https://orcid.org/0000-0001-8046-0602)
- Georgios Chalikias (ORCID: https://orcid.org/0000-0003-4331-730X)
- Anastasia Kitsiou (ORCID: https://orcid.org/0000-0002-2788-0074)
- Dimitrios Avramidis (ORCID: https://orcid.org/0000-0002-0544-9160)
- Sotirios Patsilinakos (ORCID: https://orcid.org/0000-0002-9933-2675)
- Ioannis Leontsinis (ORCID: https://orcid.org/0000-0002-6992-2906)
- Katerina Κ. Naka (ORCID: https://orcid.org/0000-0002-9900-9659)
- Maria E. Marketou (ORCID: https://orcid.org/0000-0003-1888-3430)
- Panagiotis Theofilis (ORCID: https://orcid.org/0000-0001-9260-6306)
- Vasiliki Bistola (ORCID: https://orcid.org/0000-0003-3734-5443)
- Eleni Manta (ORCID: https://orcid.org/0000-0002-5190-550X)
- Dimitrios T. Farmakis (ORCID: https://orcid.org/0000-0001-8364-3447)
- Konstantinos P Tsioufis (ORCID: https://orcid.org/0000-0002-7636-6725)
- Costas Thomopoulos (ORCID: https://orcid.org/0000-0002-8491-6029)
- George Bibis
- Evangelos K. Oikonomou (ORCID: https://orcid.org/0000-0001-8079-0599)
- Athanasios Trikas (ORCID: https://orcid.org/0000-0003-4367-805X)
- Periklis Ntavlouros
- Christos Chatzieleftheriou
- Georgios Koutsopoulos (ORCID: https://orcid.org/0009-0006-0605-6859)
- Vaios Schismenos (ORCID: https://orcid.org/0009-0006-5326-057X)
- N Argyriou
- Athanasios Kostopoulos
- Ιoannis Zarifis (ORCID: https://orcid.org/0000-0003-2984-0874)
- Ashraf Sawafta
- George Kourgianidis
Institutions
- National and Kapodistrian University of Athens (GR)
- Sismanoglio General Hospital (GR)
- AHEPA University Hospital (GR)
- General University Hospital of Patras (GR)
- Hellenic Air Force (GR)
- General Hospital of Athens G. Genimatas (GR)
- University Hospital of Larissa (GR)
- General Hospital of Drama (GR)
- Laiko General Hospital of Athens (GR)
- Ippokrateio General Hospital of Thessaloniki (GR)
- Tzaneion General Hospital (GR)
- University Hospital of Heraklion (GR)
- University General Hospital Attikon (GR)
- General Hospital of Nikea (GR)
- University Hospital of Ioannina (GR)
- Agia Olga Hospital (GR)
- Argo (Greece) (GR)
- G. Papanikolaou General Hospital (GR)
- University Hospital of Alexandroupolis (GR)
- Hippocration General Hospital (GR)
- Evangelismos Hospital (GR)
- Sotiria General Hospital (GR)
- Athens State University (US)
Publication Details
- Journal
- Biomedicines
- Published
- 2025-08-15
- DOI
- https://doi.org/10.3390/biomedicines13081987
- Primary Topic
- Potassium and Related Disorders
- Type
- article
- Field-Weighted Citation Impact
- 0.00