Increasing SGLT2 Inhibitor Use in Glomerular Diseases

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve renal and cardiovascular outcomes in patients with type 2 diabetes, chronic kidney disease, and immunoglobulin A nephropathy (IgAN), yet prescribing rates remain low. Little is known about trends in SGLT2i use in patients with glomerular disease. Methods: We used data from the Cure Glomerulopathy (CureGN) Consortium, an NIH-sponsored multicenter prospective observational cohort study of patients with biopsy-proven diagnosis of glomerular disease. A generalized estimating equation logistic model was fit for any SGLT2i use in a calendar year. Predictors included demographic (age, sex, insurance, education level, rural versus urban residency, biopsy location) and clinical characteristics (eGFR, UPCR, comorbidities, medication use). Results: We identified 1,632 adults with at least one CureGN study visit from 2020-2024. The percent of participants with a SGLT2i prescription increased from 1.8% to 21.6% overall from 2020-2024 and from 2.7% to 36.5% among those with eGFR<=75. Participants were more likely to be on an SGLT2i in later study years (p<0.0001). Other factors significantly associated with SGLT2i's included higher UPCR (p<0.0001), lower eGFR (p<0.0001), overweight/obese status (p=0.02), and attainment of a college degree or higher (p=0.006). Those with minimal change disease (p<0.0001) or membranous nephropathy (p<0.0001) were less likely to have a SGLT2i prescription compared to those with IgAN. Conclusion: SGLT2i use in glomerular disease is increasing but less than 25% of participants had a prescription in 2024. In concordance with clinical indications, patients with lower eGFR or greater UPCR were more likely to receive SGLT2i’s. Attainment of a college degree, as a proxy for health literacy or higher socioeconomic status, may improve a patient’s likelihood of receiving effective new therapies for glomerular disease. Targeted interventions addressing these factors may increase SGLT2i prescribing. Funding: NIDDK Support