Abstract: SA-PO0670
SGLT2 Inhibitors Among Middle-Aged and Older Adults with IgAN At-Risk of Progressive CKD and Cardiovascular Disease
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - Other
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Hee Jin Veronica, Ng, Lee Kong Chian School of Medicine, Singapore, Singapore
- Sim, Jovan Sao Ang, Lee Kong Chian School of Medicine, Singapore, Singapore
- Tan, Hui Zhuan, Singapore General Hospital, Singapore, Singapore
- Lee, Tung Lin, Singapore General Hospital, Singapore, Singapore
- Mok, Irene Yanjia, Singapore General Hospital, Singapore, Singapore
- Choo Chon Jun, Jason, Singapore General Hospital, Singapore, Singapore
- Lim, Cynthia Ciwei, Singapore General Hospital, Singapore, Singapore
Background
Evidence from DAPA-CKD (2021) and EMPA-kidney (2024) demonstrated SGLT2i benefits for IgA nephropathy (IgAN), leading to the 2025 KDIGO guideline recommending SGLT2i for patients at risk of progressive kidney function loss. In Singapore, SGLT2i subsidies were introduced for diabetes in 2017 and extended to chronic kidney disease in 2022. However, concerns exist regarding SGLT2i use with immunosuppressants. We described real-world SGLT2i prescription patterns among individuals with IgAN receiving immunosuppressive therapy.
Methods
We performed a single-center retrospective cohort study of individuals with biopsy-confirmed IgAN diagnosed between December 2015 and August 2025. We included visits if patients were ≥40 years and receiving immunosuppressants. The outcome was SGLT2i prescription, evaluated using mixed effects logistic regression with random intercepts for patient and follow-up year.
Results
We included 251 visits among 55 individuals ≥40 years. Median follow-up was 18 (IQR: 12, 30) months. Median age was 58 (IQR: 47, 66) years, eGFR 45.8 (IQR: 31.9, 66.2) ml/min/1.73m2, and UPCR 1.13 (IQR: 0.43, 2.22) g/g. Cardiovascular risk factors were common: diabetes (23.1%), hypertension (70.1%), hyperlipidemia (45.0%).
SGLT2i was prescribed at 70 visits (27.9%) among 12 patients. Prescription was higher in 2023-2026 (53.8%) versus 2016-2022 (15.7%) (OR 6.30, 95% CI: 2.57-15.44). SGLT2i prescription was associated with metformin use (OR 6.39, 95% CI: 1.37-29.88, p=0.02) and higher UPCR (OR 1.33, 95% CI: 0.99-1.80, p=0.06).
Conclusion
SGLT2i prescription increased after 2022, coinciding with subsidies and emerging evidence, but remains underutilized. Further studies on SGLT2i safety during immunosuppression may help overcome clinical inertia.
Acknowledgment
The authors thank the Renal Coordinator Unit and the Renal Diagnostic Unit of the Department of Renal Medicine, Singapore General Hospital for their support in the project.
Statement of Ethics: This study was conducted according to the Declaration of Helsinki and was approved by the SingHealth Central Institutional Review Board (2024-3941) including waiver of written informed consent based on ethical consideration.