Prescribing patterns of sodium-glucose cotransporter-2 inhibitors in patients with chronic kidney disease

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) reduce kidney disease progression and mortality in patients with chronic kidney disease (CKD), regardless of diabetes status. However, the prescribing patterns of these novel therapeutics in the CKD population in real-world settings remain largely unknown. Methods: This cross-sectional study included adults with stage 3-5 CKD included in the Mass General Brigham (MGB) CKD registry in March 2021. We described the adoption of SGLT-2i therapy and evaluated factors associated with SGLT-2i prescription using multivariable logistic regression models in the CKD population, with and without diabetes. Results: A total of 72,240 patients with CKD met inclusion criteria, 31,688 (44%) were men and 61,265 (85%) were White. A total of 22,653 (31%) patients were in the diabetic cohort and 49,587 (69%) were in the non-diabetic cohort. SGLT-2i prescription was 6% in the diabetic cohort and 0.3% in the non-diabetic cohort. In multivariable analyses, younger age, male sex, Black race, history of heart failure, use of cardiovascular medications, and at least one cardiologist visit in the prior year were associated with higher odds of SGLT-2i prescription in both diabetic and non-diabetic cohorts. Among patients with diabetes, advanced CKD stages were associated with lower odds of SGLT-2i prescription, whereas urine dipstick test, at least one subspecialist visit in the prior year were associated with higher odds of SGLT-2i prescription. In the non-diabetic cohort, CKD stage, urine dipstick test, and at least one nephrologist visit in the prior year were not significantly associated with SGLT-2i prescription. Conclusions: In this registry study, prescription of SGLT-2i was low in the CKD population, particularly among patients without diabetes.