Abstract
Disclosure: J. Li: None. W. Simmons: None. J. Lin: None. E. Sholle: None. D. Sawinski: None. S. Tummalapalli: None. Background: SGLT2 inhibitors (SGLT2i) have been shown in multiple clinical trials to have protective effects for chronic kidney disease (CKD) by slowing down the deterioration of eGFR over time, for both diabetic and non-diabetic kidney disease. However, SGLT2i uptake among patients with CKD is low. This study aims to examine the patient characteristics that are associated with higher SGLT2i usage, serving as baseline data for an interventional pragmatic trial aiming to increase the use of SGLT2i at our institution. Methods: A serial cross-sectional analysis was performed using electronic health record data at a large, urban teaching hospital from 4/1/2021 to 3/31/2024. Patients were included if they had been seen in ≥2 outpatient encounters, with 2 eGFR values of 20-59 mL/min/m(2) more than 90 days apart. We assessed the association of age, sex, race, insurance type, social deprivation index quintile, diabetes status, and congestive heart failure (CHF) with SGLT2i use using multivariable-adjusted logistic regression. Results: The study included 20,858 adults with a mean age of 75 years. The sample consisted of 46% males and 54% females. In terms of race and ethnicity, 45% were non-Hispanic White, 22% were non-Hispanic Black, 14% were Hispanic/Latino, 4% were Asian, and 0.1% were American Indian/Alaska Native. Mean estimated glomerular filtration rate was 43 (standard deviation [SD] 10) mL/min/m2 and mean urine albumin-to-creatinine ratio was 271 (SD 669) mg/g among the 7,839 patients with a recent UACR. Thirty-seven percent of patients were on an ACEi or ARB. Among 11,706 patients with CKD 3 or 4 without diabetes, the prevalence of SGLT2i use increased from 0.5% to 5.5% from 4/2021 to 3/2024; during the same period, 9,152 patients with CKD 3 or 4 with diabetes had increased SGLT2i use from 5.7% to 18.2%. In adjusted analyses, several factors were associated with higher likelihood of SGLT2i use, including male sex (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.36 - 1.85), Hispanic ethnicity (aOR 1.45 vs. non-Hispanic White; 1.15 - 1.83), having diabetes (aOR 2.04; 1.68 - 2.47), CHF (aOR 1.35; 1.15 - 1.59), and higher hemoglobin A1c values (aOR 1.27 per 1 unit increase; 1.21 - 1.34) (all p ≤ 0.002). Discussion: SGLT2i use was significantly higher in patients with diabetes and CHF, likely due to SGLT2i having well-known benefits in these two medical conditions. However, SGLT2i use was very low in patients with CKD 3 or 4 without these comorbid conditions. Interventions aiming at increasing SGLT2i prescriptions in patients with CKD 3 or 4 without diabetes or CHF should be considered, such as enhancing provider education on the benefit of SGLT2i on patients with CKD alone. Presentation: Saturday, July 12, 2025