Abstract: SA-PO1168
Barriers to Use of Cardio-Kidney Protective Medications in CKD: Results of a Nephrology Provider Survey
Session Information
- CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Weltman, Melanie R., University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
- Jhamb, Manisha, University of Pittsburgh Division of Renal-Electrolyte, Pittsburgh, Pennsylvania, United States
Background
Novel cardio-kidney protective medications including sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1RA), and nonsteroidal mineralocorticoid antagonists (nsMRA) are transforming chronic kidney disease (CKD) care and are recommended for use in people with CKD per KDIGO guidelines. However, overall use of these medications is suboptimal, and nephrologists prescribe only a small proportion of such medications despite strong CKD indications. In this study, we seek to elucidate barriers experienced by nephrology providers when using cardio-kidney protective therapies in CKD patients.
Methods
A brief anonymous, online survey was created based on published literature and refined in a focus group session of stakeholders from nephrology, endocrinology, cardiology, and internal medicine specialties. The final survey has 23 items and collects clinical/demographic information, prescribing experience, beliefs, and barriers to use of SGLT2i, GLP1RA, and nsMRA. Distribution to nephrology providers (physicians and advanced practice providers (APPs)) in diverse practice settings began April 2025 and is ongoing. We are targeting at least 100 responses.
Results
To date, 35 responses have been received. Thirty-three (94%) respondents are nephrologists and two (6%) are APPs. The most common practice sites reported were academic (37%), single specialty private practice (26%) and multispecialty group practice (26%). Most (83%) saw 40 or fewer CKD patients per week. Nearly half (49%) prescribed SGLT2i more than 5 times monthly, but only 3% prescribed GLP1RA or nsMRA more than 5 times monthly. Only 49% were comfortable prescribing GLP1RA, whereas 97% and 83% were comfortable prescribing SGLT2i or nsMRA. Commonly reported barriers to use of SGLT2i were patient preference/hesitation (77%), cost (71%), and polypharmacy (69%); GLP1RA were cost (86%), burdensome prior authorization procedures (74%), and uncertainty about prescribing responsibility (74%); and nsMRA were polypharmacy (71%) and cost (54%).
Conclusion
Preliminary data demonstrate that nephrology providers experience multilevel barriers to use of cardio-kidney protective medications in people with CKD. Understanding such barriers will inform future interventions aimed at improving cardio-kidney protective medication use for CKD patients.