Santé Mont Royal Medical Center, Montreal, QC, Canada.
Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC, Canada.
Ann Pharmacother. 2025 Jan;59(1):13-22. doi: 10.1177/10600280241245995. Epub 2024 May 12.
The use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in nephrology practice is increasingly becoming standard of care in patients with diabetes or those with proteinuria.
The primary outcome was to identify the proportion of pre-dialysis patients with chronic kidney disease (CKD) G3a, G3b, or G4 prescribed an SGLT2i and describe their characteristics.
This was a retrospective, multicentric, cross-sectional study of patients with CKD followed at 4 pre-dialysis clinics in the province of Quebec, Canada. We collected data of multiple covariates associated with prescribing SGLT2i in patients over 18 years of age with CKD G3a, G3b, or G4. We then performed a multivariate logistic regression to assess their associations.
Of the 874 patients included, 22.7% were prescribed an SGLT2i. Factors most strongly associated included male sex (odds ratio [OR] = 4.88, 95% CI = 2.38-10.03), being prescribed metformin (OR = 4.30, 95% CI = 2.23-8.31), having type 2 diabetes (OR = 4.00, 95% CI = 1.86-8.62), or having an albumin-to-creatinine ratio greater than 300 mg/g (OR = 1.84, 95% CI = 1.08-3.14). The majority of patients (60.4%) had their SGLT2i initiated by the pre-dialysis clinic and the most frequent adverse event was an initial increase in serum creatinine 1 week after starting treatment (33.9%).
An increasing number of patients with CKD are being prescribed SGLT2i. Nonetheless, significant disparities in sex, severity of disease, and comorbidities remain. We suggest that specific strategies be put in place to promote prescribing of SGLT2i in women and other at-risk populations, in particular among nephrology teams, to improve patient care.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）在肾病学实践中的应用日益成为糖尿病或蛋白尿患者的标准治疗方法。
主要结局是确定接受 SGLT2i 治疗的慢性肾脏病（CKD）G3a、G3b 或 G4 期透析前患者的比例，并描述其特征。
这是一项在加拿大魁北克省 4 家透析前诊所进行的回顾性、多中心、横断面研究，纳入了年龄大于 18 岁的 CKD G3a、G3b 或 G4 患者。我们收集了与 SGLT2i 处方相关的多种协变量数据，并对这些患者进行了多变量逻辑回归分析以评估其相关性。
在纳入的 874 例患者中，有 22.7%的患者处方了 SGLT2i。与 SGLT2i 处方最密切相关的因素包括男性（比值比[OR] = 4.88，95%置信区间[CI] = 2.38-10.03）、处方二甲双胍（OR = 4.30，95% CI = 2.23-8.31）、患有 2 型糖尿病（OR = 4.00，95% CI = 1.86-8.62）或白蛋白/肌酐比值大于 300 mg/g（OR = 1.84，95% CI = 1.08-3.14）。大多数患者（60.4%）在透析前诊所开始使用 SGLT2i，最常见的不良反应是治疗开始后 1 周血清肌酐初始升高（33.9%）。
越来越多的 CKD 患者开始使用 SGLT2i。然而，在性别、疾病严重程度和合并症方面仍存在显著差异。我们建议制定具体策略，促进在女性和其他高危人群中使用 SGLT2i，特别是在肾病学团队中，以改善患者的治疗效果。
