Abstract: FR-PO0250
Contemporary Use of RAS Inhibitors and SGLT2 Inhibitors in US Adults with Advanced CKD
Session Information
- CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Tajerian, Amin, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Priest, Elisa, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Mohottige, Dinushika, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- McCowan, Precious, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Butler, Javed, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Khan, Muhammad Shahzeb, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Green, Jamie Alton, Geisinger Medical Center, Danville, Pennsylvania, United States
- Jalal, Diana I., University of Iowa Health Care, Iowa City, Iowa, United States
- Fisher, Molly, Albert Einstein College of Medicine, New York, New York, United States
- Ozieh, Mukoso N., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Chang, Tara I., Stanford University, Stanford, California, United States
- Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
- Dember, Laura M., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Flythe, Jennifer E., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Shafi, Tariq, Baylor Scott & White Research Institute, Dallas, Texas, United States
Background
Advanced CKD (aCKD; eGFR<30 mL/min/1.73m2) affects ~1.1 million US adults and carries high risks of kidney failure (KF), cardiovascular (CV) events, and death. The traditional focus for this population has been on preparation for kidney replacement therapies, with less emphasis on preventing CKD progression and CV events. We sought to evaluate the current use of therapies to slow CKD progression, renin-angiotensin system inhibitors (RASi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) in US adults with aCKD.
Methods
We used EHR data from 30 US health systems (Truveta database) to identify adults (≥18 years) with aCKD (eGFR <30 mL/min/1.73m2; not receiving kidney replacement therapy) who had visits between 1/1/2024 and 12/31/2025. We evaluated RASi and SGLT2i prescriptions across eGFR strata and 2-year risk of kidney failure (KF; calculated by 4-variable KF Risk Equation) strata.
Results
We identified 106,383 individuals with aCKD; the mean age was 77 years, 58% were female, and 24% were Black (Table). Overall, only 37% were receiving RASi and 16% were receiving SGLT2i. 57% of patients were not receiving either RASi or SGLT2i; 27% were treated with RASi alone, 6% with SGLT2i alone, and only 10% with both therapies. The prescription of these medications did not differ by KF risk status. Even among individuals with a 2-year KF risk <40%, the use of RASi and/or SGLT2i was similarly low, with <10% receiving both medications.
Conclusion
Despite established efficacy and guideline recommendations, the use of RASi and SGLT2i is low in US adults with aCKD. Uncertainty about the real-world effectiveness of RASi and SGLT2i in this population could be a contributing factor and needs to be evaluated in randomized clinical trials.
Advanced CKD Population Characteristics
| Characteristic | All | Index eGFR, mL/min/1.73 m2 | Index 2-Year Kidney Failure Risk | ||
| N = 106,383 | (<20) N = 33,449 | (20-30) N = 72,934 | <40% N = 95,070 | ≥40% N = 11,313 | |
| Age, years | 77 (68, 84) | 74 (64, 82)* | 78 (70, 85)* | 78 (70, 85)* | 63 (52, 72)* |
| Female sex | 61,529 (58%) | 18,633 (56%) | 42,896 (59%) | 56,833 (60%)* | 4,696 (42%)* |
| Black Race | 25,400 (24%) | 9,338 (28%)* | 16,062 (22%)* | 21,744 (23%)* | 3,656 (32%)* |
| Hispanic | 8,656 (8%) | 3,441 (10%)* | 5,215 (7%)* | 6,915 (7%)* | 1,741 (15%)* |
| Most recent eGFR, mL/min/1.73 m2 | 24 (18, 27) | 15 (12, 18)* | 26 (23, 28)* | 24 (20, 27)* | 11 (7, 15)* |
| Urine albumin-creatinine ratio, mg/g | 221 (49, 917) | 582 (130, 1,774)* | 142 (37, 591)* | 142 (39, 519)* | 2,157 (1,170, 3,740)* |
| 2-year KF Risk, % | 10 (6, 20) | 27 (17, 46)* | 7 (5, 11)* | 8 (5, 15)* | 57 (47, 71)* |
| Current RASi use | 39,748 (37%) | 10,340 (31%)* | 29,408 (40%)* | 36,098 (38%)* | 3,650 (32%)* |
| Current SGLT2i use | 16,642 (16%) | 3,786 (11%)* | 12,856 (18%)* | 12,884 (16%) | 3,758 (14%) |
| Cardiovascular disease | 73,107 (66%) | 21,937 (66%) | 51,170 (70%) | 66,844 (70%)* | 6,263 (55%)* |
| Diabetes mellitus | 65,680 (62%) | 20,940 (63%) | 44,740 (61%) | 58,168 (61%)* | 7,512 (66%)* |
Median (Q1, Q3) or Frequency (%); *Standardized mean difference > 0.1