A New Era in Kidney Disease Treatment? Rapid Adoption of SGLT2 Inhibitors and GLP-1 Receptor Agonists Signals Shifting Paradigms

Background: While SGLT2 inhibitors and GLP-1 receptor agonists were initially approved for the treatment of type 2 diabetes, both drug classes have demonstrated significant cardiovascular and renal benefits, leading to FDA approvals of agents like dapagliflozin and empagliflozin for chronic kidney disease (CKD). As such, nephrologists are adopting a comprehensive treatment strategy incorporating SGLT2 inhibitors and GLP-1 agonists early in the CKD treatment paradigm to slow disease progression and prolong the timeline to dialysis. Methods: Data was collected from 1,048 non-dialysis patient charts submitted by 197 U.S. nephrologists from 10/10/24-11/20/24, plus trended data from similar studies from 2020 to 2023. Results: Once met with hesitation, nephrologists are now much more willing to prescribe SGLT2is and GLP-1s. Just 4% of nephrologists (down from 26% in 2020) report not wanting to manage a patient’s diabetes regimen as a reason for not prescribing SGLT2is to Diabetic Kidney Disease (DKD) patients and 18% (down from 60%) say that a CKD patient not having diabetes is a reason for not prescribing. Similarly, just 6% of nephrologists cite not wanting to manage a patient’s diabetes regimen as a reason for not prescribing a GLP-1. SGLT2 inhibitors are now routinely prescribed by nephrologists due to their proven CKD benefits. Approximately 60% of DKD patients (up from 49% in 2022) and 25% of non-DKD patients (up from 14% in 2022) are currently treated with an SGLT2 inhibitor, signaling strong belief in their renal protective benefits. GLP-1 agonists have also seen notable growth in CKD-ND patients over the past few years (13% in 2024 vs. 8% in 2023), with nephrologists playing an increasingly prominent role in prescribing them. Prescribing is driven by multiple factors, including weight loss, glucose control, and enhanced CKD management and improved renal outcomes. Conclusion: As SGLT2 inhibitors and GLP-1s are incorporated into CKD care, the beginnings of a new standard of care are emerging that may ultimately shift the trajectory of diabetic, and non-diabetic kidney disease, long before patients need dialysis. The evolving landscape of CKD management presents significant opportunities to improve patient outcomes through the strategic use of these agents.