Prescription Patterns of Sodium-Glucose Co-Transporter 2 Inhibitors among Nephrologists

Background Over the past decade, the therapeutic role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) has evolved from oral hypoglycemic agents to agents with proven cardio- and reno-protective benefits, including use in non-diabetic kidney disease. Despite being one of the four pillars of chronic kidney disease management, real-world prescribing trends remain poorly characterized. Materials and Methods This retrospective observational study analyzed electronic medical records of patients attending the nephrology outpatient department at a tertiary care hospital to determine the proportion of patients prescribed an SGLT2 inhibitor among those with a Class Ia guideline recommendation. Subsequently, an online questionnaire-based survey was conducted among nephrologists to identify barriers to SGLT2i prescription. Results Among 5,701 patients who attended the Nephrology outpatient department in 2024, 399 met the criteria for Class Ia indication for SGLT2i therapy. The overall prescription rate was 20.3%, with 18.7% in patients with diabetes mellitus and 24.7% in those without. Factors significantly associated with SGLT2i prescription included younger age ( p = 0.004), presence of albuminuria ( p = 0.033), concomitant use of renin-angiotensin-aldosterone system (RAAS) inhibitors ( p = 0.002), and higher estimated glomerular filtration rate (eGFR) ( p = 0.026). Among 55 nephrologists who participated in the survey, only 55% reported prescribing SGLT2i in >25% of eligible patients. Conclusion Despite robust evidence supporting their benefits, SGLT2i prescription rates remain suboptimal among patients with Class Ia indications. Strategies such as early nephrology referral and educational initiatives to enhance awareness may improve the uptake of guideline-recommended therapy.