Kidney Week

Abstract: FR-PO0289

Baseline Assessment of SGLT2 Inhibitor Underuse in Outpatient CKD Clinics: A Quality Improvement Initiative

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

• Shafiq, Ihtesham, The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States

Ihtesham Shafiq, MD

• Jan, Muneeb Ullah, The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States

Muneeb Ullah Jan, MD

• Shah, Syed Muhammad Obaida M., The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States

Syed Muhammad Obaida M. Shah, MD

• Gyamlani, Geeta G., VA Memphis Healthcare System, Memphis, Tennessee, United States

Geeta G. Gyamlani, MD, FASN

• Naseer, Adnan, VA Memphis Healthcare System, Memphis, Tennessee, United States

Adnan Naseer, MD

• Hussein, Wael F., The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States

Wael F. Hussein, MBBS, MSc, FASN

Background

SGLT2 inhibitor (SGLT2i) therapy is strongly recommended in management of CKD patients. However, utilization in clinical practice has been slow. We aimed to evaluate physician prescribing frequency of SGLT2 inhibitors in local nephrology clinics to establish the baseline status for a QI project.

Methods

We evaluated patients presenting for office visits at two fellow-assisted nephrology clinics in Nov and Dec 2025. We extracted data on indications for SGLT2i and prescriptions. Patients were considered to have a guideline-based prescribing opportunity if they had CKD with eGFR ≥ 20 ml/min/1.73 m² and diabetes mellitus (DM2), ACR ≥ 200 mg/g, or heart failure (HF). We also evaluated a broader eligibility definition that included patients with eGFR 20 – 45 ml/min/1.73 m².

Results

During the observation period, 69 patients were seen at the two clinics. Median eGFR was 32 (IQR 27 – 42) ml/min/1.73 m2, 87% had eGFR ≥ 20 ml/min/1.73 m2, 59% had DM2, and 13% HF. Albuminuria < 30, 30 – 299, and ≥ 300 mg/g was present in 32%, 39%, and 26% of patients respectively. A guideline-based prescribing opportunity was identified in 41 (59%) patients, while 57 (83%) met the broader eligibility definition.
An SGLT2i prescription was observed in 61% meeting the guideline-based prescribing criteria and 56% of patients meeting the broader eligibility definition, leaving 25 (44%) eligible patients untreated. Only four untreated eligible patients had a documented reason for non-treatment. Documented reasons were recurrent UTI, urinary symptoms, worsening renal function, and prior discontinuation during hospitalization.

Conclusion

Baseline findings from this QI initiative identified frequent missed opportunities for SGLT2i therapy, supporting the need for interventions that focus on education, prescribing workflows, and adverse effect management.