Kidney Week

Abstract: SA-PO0423

Prescription Trends and Kidney Outcomes Associated with SGLT2 Inhibitor Use in Patients with Type 2 Diabetes and CKD

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Yao, Jie, SingHealth Group, Singapore, Singapore

Jie Yao, MD

• Lim, Gek hsiang, Singapore General Hospital, Singapore, Singapore

Gek hsiang Lim

• Choo Chon Jun, Jason, Singapore General Hospital, Singapore, Singapore

Jason Choo Chon Jun, MBBS, FASN

• Bee, Yong Mong, Singapore General Hospital, Singapore, Singapore

Yong Mong Bee, MBBS

• Tan, Ngiap chuan, SingHealth Polyclinics, Singapore, Singapore

Ngiap chuan Tan, MBBS

• Anantharaman, Saradha, Changi General Hospital, Singapore, Singapore

Saradha Anantharaman, MBBS

• Tay, Hui Boon, Sengkang General Hospital, Singapore, Singapore

Hui Boon Tay, MBBS

• Kwek, Jia Liang, Singapore General Hospital, Singapore, Singapore

Jia Liang Kwek, MBBS

• Liew, Zhong Hong, Singapore General Hospital, Singapore, Singapore

Zhong Hong Liew, MD, MPH, FASN

Background

Chronic kidney disease (CKD) is a growing global health burden with rising prevalence. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have become the cornerstone therapy for patients with CKD and type 2 diabetes mellitus (T2DM) for their established cardiorenal protective benefits. However, real-world uptake remains suboptimal. Our study aimed to identify determinants of SGLT2i prescription and evaluate its real-world impact on renal outcomes in a T2DM population with CKD indications.

Methods

In this retrospective cohort study using SingHealth Diabetes Registry, patients aged >= 21 years with T2DM and CKD (eGFR < 60 ml/min/1.73 m² or albuminuria >= 30 mg/g) were included. The primary outcome was a composite renal endpoint including doubling of serum creatinine, end-stage kidney disease or renal/cardiovascular related death. Dominance analysis and multivariable models with backward elimination identified prescription facilitators. Cox regression was utilized to evaluate the association between SGLT2-i use and renal outcomes across various subgroups.

Results

SGLT2-i prescription rates increased from 0.93% in 2016 to 28.8% in 2023. Age was the most influential factor for prescription, followed by HbA1c, CKD stage, prior ischemic heart disease, and BMI. SGLT2-i treatment was associated with a significantly lower hazard of the composite renal outcome (HR 0.57; 95% CI 0.42–0.78; p<0.001). This benefit remained significant across most subgroups (gender, age, ethnicity, CKD stage 1 to 4, hypertension, ischemic heart disease, and healthcare institution). No significant association was observed in patients with albuminuria <300 mg/day or BMI < 18.5 kg/m2.

Conclusion

Out study confirmed the renoprotective effect of SGLT2i in our local population with T2DM and CKD. However, the prescription rate remains suboptimal despite clear indications. Under usage is most pronounced in older adults and those with lower eGFR, groups that stand to benefit substantially from cardiorenal protection. Targeted interventions are necessary to bridge this evidence practice gap and optimize CKD management.