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.

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.
Competing Interests: The Renal Division of The George Institute for Global Health has received sponsorship funding provided by Boehringer Ingelheim and Eli Lilly Alliance, and is supported by the University of New South Wales Scientia Program. The design, analysis, interpretation or writing of this manuscript was performed independent of all funding bodies. All study authors assumed final responsibility for all aspects of the study, including the decision to submit the manuscript for publication. BLN has received fees for travel support, advisory boards, scientific presentations and steering committee roles from AstraZeneca, Bayer, Boehringer and Ingelheim, Cambridge Healthcare Research, Janssen, and Medscape with all honoraria paid to The George Institute for Global Health. He serves as Secretariat of the SGLT2 Meta-Analysis Cardio-Renal Trialists Consortium and is a member of the Caring for Australians and New Zealanders with Kidney Impairment (CARI) living guidelines on SGLT2 inhibitors. MJ is responsible for research projects that have received unrestricted research funding from Boehringer Ingelheim and Eli Lilly Alliance. SK has received consultancy fees from Chinook and Dimerix Pharmaceuticals. This study was supported by an unrestricted research grant from Boehringer Ingelheim. SVB has served on advisory board of Bayer, AstraZeneca, GSK and Vifor Pharma; received speakers fees from Bayer, AstraZeneca, Pfizer and Vifor Pharma, and non-financial research support from Bayer with all fees paid to his institution. MJJ is supported by an NHMRC Investigator Grant; is responsible for research projects that have received funding from Amgen, Baxter, CSL, Dimerix, Eli Lilly, Gambro, and MSD; has received fees for Advisory, Steering Committee and/or Scientific Presentations from Akebia, Amgen, Astra Zeneca, Baxter, Bayer, Boehringer Ingelheim, Cesas Linx, Chinook, CSL, Janssen, Medscape, MSD, Occuryx, Roche and Vifor; with any consultancy, honoraria or travel support paid to her institution. VP has received fees for advisory boards, steering committee roles, or scientific presentations from AbbVie, Astellas, AstraZeneca, Bayer, Baxter, BMS, Boehringer Ingelheim, Dimerix, Durect, Eli Lilly, Gilead, GSK, Janssen, Merck, Mitsubishi Tanabe, Mundipharma, Novartis, Novo Nordisk, Pfizer, Pharmalink, Relypsa, Retrophin, Sanofi, Servier, Tricida, and Vitae. MW has received consultancy fees from Amgen and Freeline.
(© 2023 The Author(s).)