Kidney Week

Abstract: TH-PO0370

Sex Differences in SGLT2 Inhibitor Use Complicating a Treatment Optimization Program in a Large Network of Nephrology Practices

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

• Eisenbeisz, McKenna, Stanford University School of Medicine, Stanford, California, United States

McKenna Eisenbeisz, MD

• Marcus, Roy G., Panoramic Health, Tempe, Arizona, United States

Roy G. Marcus, MD

• Kwon, Katherine Westin, Panoramic Health, Tempe, Arizona, United States

Katherine Westin Kwon, MD, FASN

• Mooney, Ann, Panoramic Health, Tempe, Arizona, United States

Ann Mooney, APN, RN

• Eckhardt, Douglas, Panoramic Health, Tempe, Arizona, United States

Douglas Eckhardt, MBA

• Pu, Jie, Panoramic Health, Tempe, Arizona, United States

Jie Pu

• Alonso, Liz, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States

Liz Alonso

• Williams, Jason, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States

Jason Williams, MBA

• Desai, Pooja N., AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States

Pooja N. Desai, PhD

• Chertow, Glenn M., Stanford University School of Medicine, Stanford, California, United States

Glenn M. Chertow, MD, MPH, FASN

Background

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have a prominent role in the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) Chronic Kidney Disease (CKD) guidelines to reduce CKD progression and reduce the risk of hospitalization. We designed an initiative to increase the use of SGLT2i in over 75,000 CKD patients with an SGLT2i indication.

Methods

We measured baseline SGLT2i use at the practice and physician level. We surveyed physicians to learn why they are reluctant to prescribe SGLT2i. The main concern was genitourinary (GU) infection risk. We shared educational materials on the low GU infection risk in the major SGLT2i trials and infection prevention strategies. We stressed SGLT2i benefits and affordability information. Practices received SGLT2i use rates by provider on a regular cadence.

Results

In November 2024, SGLT2i utilization in patients with an indication based on KDIGO 2024 CKD guidelines was 11%. By April 2025, SGLT2i use increased to 40.0% in indicated patients with usage 44.8% in males and 34.4% in females. Higher usage in males occurred in all 22 practices. Males had higher rates of diabetes (M=68.4%, F=65.5%*), heart failure (M=12.5%, F=10.2%*), and albumin-to-creatinine ratio (ACR) (Median (P_25% , P_75%): M=109 (24,456), F=68 (18, 316)*) than females. However, male female differences persisted within specific subcategories: diabetes (M=51.9%, F=41.9%*), heart failure (M=47.3%, F=36.9%*) and ACR≥300 (M=55.2%, F=45.3%*). * Signifies P<0.0001

Conclusion

There are significant sex differences in SGLT2i utilization across our large data set as well as in every individual practice. The difference in SGLT2i use between male and female patients with an indication is not due to a lower prevalence of diabetes, heart failure, or albuminuria in female patients since the discrepancy between males and females persisted in each of these subgroups. The previously identified provider concern about GU infections may be the cause of this difference. Additional efforts are needed to identify the cause and work to close the gap, given the substantial benefit of SGLT2i’s, their ability to significantly reduce CKD progression, mitigate heart failure risks, and lower hospitalization rates.

Funding

• Commercial Support – AstraZeneca

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025sxp6qg42