Abstract: PUB369
Real-World SGLT2 Inhibitor (SGLT2i) Use in Patients with CKD in the United States
Session Information
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Kovesdy, Csaba P., The University of Tennessee Medical Center, Knoxville, Tennessee, United States
- Frankel, Andrew H., Imperial College London, London, England, United Kingdom
- Kashihara, Naoki, Kawasaki Ika Daigaku, Kurashiki, Okayama Prefecture, Japan
- Du, Chengan, Boehringer Ingelheim Corp USA, Ridgefield, Connecticut, United States
- Kato, Sota, Nippon Boehringer Ingelheim Kabushiki Kaisha, Shinagawa, Tokyo, Japan
- Hunnicutt, Jake, Boehringer Ingelheim Corp USA, Ridgefield, Connecticut, United States
Background
CKD affects ~35 million US adults and is associated with type 2 diabetes (T2D) and cardiovascular disease, including heart failure (HF). Use of SGLT2i therapies prior to US approval of empagliflozin remains unclear.
Methods
This study identified US adults (>18 years) with stage 1–5 diagnosed CKD (Optum Market Clarity). Demographics and use of SGLT2i and other medications in the year prior to approval of empagliflozin for CKD (Sep 21, 2023) were stratified by comorbidities (T2D and/or HF) and stage G3–5 CKD (by estimated glomerular filtration rate [eGFR], in patients with available data).
Results
In total, 1,443,403 patients with CKD were identified (median [IQR] age: 75 [66–82] years; 50.4% female; 28.0% had eGFR data available to estimate CKD stage, of which 65.1% had G3–5 CKD) (Table). Overall, 26.9% had CKD only, 37.6% had CKD and T2D only, 13.7% had CKD and HF only, and 21.8% had CKD and T2D+HF; age and sex were broadly similar across subgroups. SGLT2i were prescribed to 14.8% of patients (from 1.8% [CKD only] to 24.3% [CKD+T2D+HF]). Renin–angiotensin system inhibitors (RASi) were prescribed to ~50% of patients across comorbidities. Other CKD-related medications including finerenone and mineralocorticoid receptor agonists (MRAs) were less frequently prescribed but most frequent in patients with HF. SGLT2i and other CKD-related medication use remained relatively low in patients with stage G3–5 CKD.
Conclusion
Prior to approval of empagliflozin in Sep 2023, SGLT2i use was low and appeared suboptimal, especially in patients with CKD only; this low use persisted among patients with lab-defined G3–5 CKD. Use of other CKD-related medications also appeared low but varied in line with recommended management of CKD with/without cardiometabolic comorbidities.
Table
Funding
- Commercial Support – Boehringer Ingelheim & Eli Lilly and Company Alliance