Abstract: TH-PO0382
National Trends in Use of CKD Guideline-Directed Medical Therapies
Session Information
- Diabetic Kidney Disease: From Early Biomarkers to Novel Therapeutic Targets
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Adhikari, Rishav, Stanford University School of Medicine, Stanford, California, United States
- Muralidharan, Jananee, Atropos Health, Palo Alto, California, United States
- Bhalla, Vivek, Stanford University School of Medicine, Stanford, California, United States
Background
Three new classes of medications slow progression of chronic kidney disease (CKD): sodium-glucose cotransporter 2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and non-steroidal mineralocorticoid receptor antagonists (nsMRAs). Prior data, although limited to individual healthcare systems, individual drug classes, and calendar years soon after clinical trial and guideline publications, has indicated slow uptake of these new guideline-indicated therapies. In this study, we characterized trends in medication use in a temporally updated national cohort.
Methods
We analyzed data from 1/1/2019-12/27/2024 in the Apollo dataset, which contains insurance claims data and electronic medical records for 66 million Americans. We included adults with a diagnosis of CKD stage 3, T2DM, and urine albumin-to-creatinine ratio ≥30 mg/g. We excluded patients with <1 year of enrollment data, CKD stage 5, or end-stage renal disease. We analyzed prescriptions of SGLT2is, GLP-1 RAs, nsMRAs, angiotensin-converting enzyme inhibitors (ACEis), and angiotensin receptor blockers (ARBs). Data were provided by Atropos Health.
Results
We identified 21,149 patients with CKD, T2DM, and albuminuria with mean age 69. Over the study period, most used ACEis/ARBs (89%), while a minority used SGLT2is (40%), GLP-1 RAs (33%), or nsMRAs (1.4%). For 20%, both SGLT2is and GLP-1 RAs were prescribed. From 2019-2024, prescriptions for ACEis/ARBs per year remained consistently high (~80%) while use of SLGT2is and GLP-1 RAs increased substantially (9.5% to 41.8% for SGLT2is; 13.3% to 32.3% for GLP-1 RAs). Use of nsMRAs was 0.8% in 2022 compared to 2.0% in 2024. Patients with heart failure or obesity were slightly more likely to receive an SGLT2i or GLP-1 RA, respectively. Prescriptions of all these CKD therapies were slightly higher among patients with macro vs microalbuminuria.
Conclusion
Our data demonstrate a substantial increase in use of newer classes of medications to slow progression of CKD, including SGLT2is, GLP-1 RAs, and nsMRAs, since publication of favorable clinical trials and guidelines. However, in a national sample of patients with CKD stage 3, T2DM, and albuminuria, the majority of patients who could most benefit from newer CKD pharmacotherapies are not receiving them, resulting in a critical gap in our ability to mitigate progression of their high-risk disease.