Abstract: FR-PO0253
Declining Rates of RAS Inhibitor Use Coinciding with Availability of Newer Therapies for Patients with 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
- Ku, Elaine, University of California San Francisco School of Medicine, San Francisco, California, United States
- Wang, Yifei, University of California San Francisco School of Medicine, San Francisco, California, United States
- McCulloch, Charles E., University of California San Francisco School of Medicine, San Francisco, California, United States
- Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
Background
CKD guidelines recommend a multimodal approach to slow the progression of chronic kidney disease (CKD), including the use of renin-angiotensin system inhibitors (RASi), sodium-glucose co-transporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP1RA). Our objective was to evaluate temporal trends in the incidence and prevalence of RASi, SGLT2i, and GLP1RA use in CKD.
Methods
The Optum Labs Data Warehouse (OLDW) is a longitudinal real-world data asset with de-identified administrative claims and electronic health record data. Using data from 2010 to 2025, we assessed the incidence and prevalence of use of medications (RASi, SGLT2i, GLP1RA) that slow CKD progression in CKD stages 3-5. Incident use was defined as a new prescription following a 1-year period without an active prescription; prevalent use was defined as filling a prescription in the current and prior year for these drugs. Cox proportional hazards models with smoothed cubic splines by year were used to evaluate temporal trends, treating 2013 as the reference year (2013 was when SGLT2i gained FDA approval in the US).
Results
Among 4,748,979 adults with CKD (mean age 62 years [SD 16]; 19% Black), new users of RASi declined over time, with the hazard for starting RASi being 28% lower in 2025 vs 2013 (95% CI 27-29%) [Figure]. In contrast, new users of SGLT2i and GLP1RA have increased steadily with the hazards in 2025 being 18.1 (95% CI 17.6,18.6) and 9.2 (95% CI 8.8,9.6) times higher than hazards in 2013, respectively. These trends were similar when we stratified trends by presence or absence of diabetes mellitus, albuminuria, and obesity.
Conclusion
In this cohort of nearly 5 million adults with CKD, new users of RASi have declined steadily since peaking in 2013, while new users of SGLT2i and GLP1RA increased steadily between 2013 and 2025. Further investigation into the reasons for these observations are warranted given that current guideline recommendations support the concurrent (rather than selective and isolated) use of RASi with SGLT2i or GLP1RA in patients with CKD.
Acknowledgment
NIDDK
Funding
- NIDDK Support