Abstract: SA-PO0971
Use of SGLT2 Inhibitors in West Virginia: A Cross-Sectional Study
Session Information
- Diversity and Equity in Kidney Health
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Shukr, Maan, West Virginia University, Morgantown, West Virginia, United States
- Schmidt, Rebecca J., West Virginia University, Morgantown, West Virginia, United States
- Shawwa, Khaled, West Virginia University, Morgantown, West Virginia, United States
Background
Sodium–glucose cotransporter-2 inhibitors (SGLT2is) have been shown to slow chronic kidney disease (CKD) progression and reduce cardiovascular mortality across diverse populations. Despite their proven benefit, adoption in clinical practice remains limited, with prior studies demonstrating cost related, racial, and geographic disparities in prescribing patterns. Appalachia, a predominantly rural U.S. region with longstanding poverty, represents a high-risk population where these disparities may be particularly pronounced.
Methods
We conducted a cross-sectional study of 13,641 adults with CKD identified from the CKD registry at West Virginia University. County-level poverty rates were obtained from the U.S. Census Bureau and linked by patient county of residence. Demographics, comorbidities, and medication use were compared between groups using chi-square and t-tests. Logistic regression model was performed for the adjusted analysis.
Results
Among 13,641 CKD patients (45% female, mean age 71.8 years), 4,453 (33%) received SGLT2is. Compared with non-users, SGLT2is users were younger, more often male, more likely to have diabetes and heart failure, and resided in counties with lower poverty rates (14.7% vs. 15.4%, P<0.0001).
In multivariable analysis adjusted for comorbidities, insurance type, age, proteinuria, Body Mass Index (BMI) and estimated Glomerular Filtration Rate (eGFR), patients residing in higher poverty counties were significantly less likely to receive SGLT2is, with an estimated 6% reduction in odds for each 1% increase in poverty (OR 0.94, 95% CI 0.93–0.95, P<0.0001). Other independent predictors of use included diabetes (OR 5.53), heart failure (OR 1.75), and use of Renin-Angiotensin-Aldosterone System (RAAS) blockade (OR 1.71).
Conclusion
Across West Virginia, SGLT2is were prescribed to younger patients with diabetes, heart failure, and greater comorbidity burden. However, patients living in counties with higher poverty rates had significantly lower odds of receiving SGLT2is, independent of clinical factors, underscoring socioeconomic disparities in access to evidence-based CKD therapies.