EXPLORING PRESCRIPTION PATTERNS OF SGLT2 INHIBITORS IN CKD PATIENTS WITHOUT DIABETES MELLITUS OR HEART FAILURE: MITIGATING CARDIOVASCULAR HEALTH EVENTS

Therapeutic Area

Kidney Disease

Background

Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease (CKD) management guidelines have a level 1A recommendation for initiating sodium-glucose cotransporter-2 inhibitors (SGLT2i) in CKD patients without diabetes mellitus (DM) or heart failure (HF) as it has demonstrated benefits in reducing risks of heart failure hospitalizations and cardiovascular death. However, real-world prescription patterns remain unclear, particularly on the influence of social determinants of health (SDOH).

Methods

A retrospective review was conducted on CKD patients without DM or HF at two outpatient academic medical centers in the Midwest between 2023 and 2024. SDOH was performed during the visits. Multivariate logistic regression adjusted for baseline characteristics, comorbidities, and SDOH. Outcomes were analyzed using descriptive statistics, t-tests, and chisquare tests. Statistical significance was set at a p < 0.05.

Results

Out of 378 CKD patients without DM or HF, only 5.82% were prescribed SGLT2i. Their mean age was 68 years. SGLT2i were less likely to be prescribed to males (27.27%), Asians (4.55%), and Hispanics (4.55%). While statistical significance was not achieved, a high prevalence of housing instability, food insecurity, lack of transportation, health illiteracy, and depression was observed among patients not receiving SGLT2i.

Conclusions

Despite strong guideline recommendations, our study reveals a significant gap in SGLT2i utilization in CKD patients without DM or HF. Lower prescription rates among men, Asians, and Hispanics, suggest potential cultural barriers, socioeconomic constraints, and implicit biases. Overall, low prescription rates suggest broader systemic issues, including slow adoption of evidence-based practices and poor SDOH integration into clinical workflow. Addressing these disparities requires improved healthcare access and promoting equity. Future research should explore larger, more diverse cohorts to better understand prescribing patterns, assess the impact of SDOH, and develop targeted strategies to improve cardiovascular and kidney health outcomes in this population.