Implementation of chronic kidney disease guidelines for sodium-glucose co-transporter-2 inhibitor use in primary care in the UK: a cross-sectional study.
In a UK primary-care cross-sectional study of over 516,000 adults with CKD, SGLT2 inhibitors were prescribed to only 17.0% of those with a guideline-directed indication, with virtually no uptake among patients without type 2 diabetes.
Background
The cardiovascular and kidney benefits of SGLT2 inhibitors in chronic kidney disease (CKD) are well established and reflected in multiple UK and international guidelines. However, real-world implementation of updated SGLT2 inhibitor guidance in the broad CKD population had remained largely unknown.
Study design
This cross-sectional study used pseudonymized electronic health record data from adults with CKD registered in the Oxford-Royal College of General Practitioners Research and Surveillance Centre network as of 31 December 2022. CKD was identified by SNOMED CT diagnostic codes and laboratory-confirmed KDIGO criteria, and logistic regression identified factors associated with SGLT2 inhibitor prescribing across four contemporary UK and international guidelines.
Key findings
Of 6,670,829 adults, 516,491 (7.7%) had CKD, of whom 26.8% had a guideline-directed indication for SGLT2 inhibitor treatment. SGLT2 inhibitors were prescribed to only 17.0% of indicated patients, almost entirely among those with co-existing type 2 diabetes (22.0%) versus less than 0.1% in those without. In adjusted analysis, females, individuals of Black ethnicity, those of lower socio-economic status, and those with lower eGFR or albuminuria were paradoxically less likely to be prescribed an SGLT2 inhibitor.
Clinical implications
SGLT2 inhibitor guidelines in CKD have not yet been successfully implemented in routine UK practice, most notably in patients without type 2 diabetes. Because individuals at higher risk of adverse outcomes were less likely to receive treatment, the authors call for enhanced efforts to embed SGLT2 inhibitors equitably into CKD care, while noting the short interval between guideline publication and data extraction as a possible limitation.
Category
Research
Source
EClinicalMedicine
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