Estimating the population-level impacts of improved uptake of SGLT2 inhibitors in patients with chronic kidney disease: a cross-sectional observational study using routinely collected Australian primary care data

Brendon L Neuen; Min Jun; James Wick; Sradha Kotwal; Sunil V Badve; Meg J Jardine; Martin Gallagher; John Chalmers; Kellie Nallaiah; Vlado Perkovic; David Peiris; Anthony Rodgers; Mark Woodward; Paul E Ronksley

doi:10.1016/j.lanwpc.2023.100988

Estimating the population-level impacts of improved uptake of SGLT2 inhibitors in patients with chronic kidney disease: a cross-sectional observational study using routinely collected Australian primary care data

Lancet Reg Health West Pac. 2023 Dec 18:43:100988. doi: 10.1016/j.lanwpc.2023.100988. eCollection 2024 Feb.

Authors

Brendon L Neuen^{1

2}, Min Jun¹, James Wick³, Sradha Kotwal^{1

4}, Sunil V Badve^{1

5}, Meg J Jardine^{6

7}, Martin Gallagher^{1

8}, John Chalmers¹, Kellie Nallaiah¹, Vlado Perkovic^{1

9}, David Peiris¹, Anthony Rodgers¹, Mark Woodward^{1

10}, Paul E Ronksley^{11

12}

Affiliations

¹ Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
² Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
³ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Nephrology, Prince of Wales Hospital, Sydney, Australia.
⁵ Department of Renal Medicine, St George Hospital, Sydney, Australia.
⁶ NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia.
⁷ Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
⁸ Department of Renal Medicine, Liverpool Hospital, Sydney, Australia.
⁹ Faculty of Medicine, University of New South Wales, Sydney, Australia.
¹⁰ The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
¹¹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹² O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Abstract

Background: Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of kidney failure and death in patients with chronic kidney disease (CKD) but are underused. We evaluated the number of patients with CKD in Australia that would be eligible for treatment and estimated the number of cardiorenal and kidney failure events that could be averted with improved uptake of SGLT2 inhibitors.

Methods: This cross-sectional observational study leveraged nationally representative primary care data from 392 Australian general practices (MedicineInsight) between 1 January 2020 and 31 December 2021. We identified patients that would have met inclusion criteria of key SGLT2 inhibitor trials and applied these data to age and sex-stratified estimates of CKD prevalence for the Australian population (using national census data), estimating the number of preventable events using trial event rates. Key outcomes included cardiorenal events (CKD progression, kidney failure, or death due to cardiovascular or kidney disease) and kidney failure.

Findings: In MedicineInsight, 44.2% of adults with CKD would have met CKD eligibility criteria for an SGLT2 inhibitor; baseline use was 4.1%. Applying these data to the Australian population, 230,246 patients with CKD would have been eligible for treatment with an SGLT2 inhibitor. Optimal implementation of SGLT2 inhibitors (75% uptake) could reduce cardiorenal and kidney failure events annually in Australia by 3644 (95% CI 3526-3764) and 1312 (95% CI 1242-1385), respectively.

Interpretation: Improved uptake of SGLT2 inhibitors for patients with CKD in Australia has the potential to prevent large numbers of patients experiencing CKD progression or dying due to cardiovascular or kidney disease. Identifying strategies to increase the uptake of SGLT2 inhibitors is critical to realising the population-level benefits of this drug class.

Funding: University of New South Wales Scientia Program and Boehringer IngelheimEli Lilly Alliance.

Keywords: Cardiovascular disease; Chronic kidney disease; End-stage kidney disease; Epidemiology; Sodium glucose cotransporter 2 inhibitors.