Department of Renal Medicine, Singapore General Hospital, Singapore City, Singapore.
Department of Internal Medicine, Singapore General Hospital, Singapore City, Singapore.
Cardiorenal Med. 2024;14(1):443-453. doi: 10.1159/000540493. Epub 2024 Jul 21.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended in kidney disease and heart failure to reduce adverse clinical outcomes, but utilization can vary. To understand potential gaps in clinical practice and identify opportunities for improvement, we aimed to describe the prevalence and factors associated with SGLT2i prescription in patients with reduced kidney function hospitalized for fluid overload and/or heart failure.
Single-center observational study of patients with reduced kidney function (eGFR 20-59 mL/min/1.73 m2) hospitalized for fluid overload or heart failure between January 2022 and December 2023. Data were retrieved from electronic medical records. The outcome was SGLT2i prescription at discharge. Potential variables affecting SGLT2i prescription were identified during stakeholder engagement and evaluated using multivariable logistic regression.
Among 2,543 patients, the median age was 79 (71, 86) years and admission eGFR was 38.7 (28.4, 49.4) mL/min/1.73 m2. SGLT2i was prescribed to 630 (24.8%) patients at discharge. SGLT2i prescription at discharge was independently associated with cardiovascular disease (OR 1.76, 95% CI: 1.31-2.35), diabetes (OR 1.59, 95% CI: 1.19-2.14), fluid overload or heart failure as the primary discharge diagnosis (OR 1.71, 95% CI: 1.29-2.28), SGLT2i pre-hospitalization (OR 104.91, 95% CI: 63.22-174.08), RAS blocker (OR 2.1, 95% CI: 1.65-2.89), and higher eGFR (OR 1.01, 95% CI: 1.003-1.02) at discharge; but inversely associated with older age (OR 0.97, 95% CI: 0.96-0.98).
SGLT2i prescription at discharge was suboptimal among patients with reduced kidney function hospitalized for fluid overload and/or heart failure, especially in older age and more severe kidney disease. Additionally, cardiovascular disease, diabetes, primary discharge diagnosis of fluid overload or heart failure, prior SGLT2i use, and concurrent RAS blocker at discharge were independently associated with SGLT2i prescription at discharge. Interventions are needed to increase clinicians' knowledge and overcome clinical inertia to increase SGLT2i use in patients with fluid overload and heart failure.
钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2i) 被推荐用于肾脏疾病和心力衰竭以降低不良临床结局，但利用率可能存在差异。为了了解临床实践中的潜在差距并确定改进的机会，我们旨在描述肾功能降低（eGFR 20-59 mL/min/1.73 m2）患者住院治疗液体超负荷和/或心力衰竭期间 SGLT2i 处方的患病率和相关因素。
对 2022 年 1 月至 2023 年 12 月期间因液体超负荷或心力衰竭住院的肾功能降低（eGFR 20-59 mL/min/1.73 m2）患者进行单中心观察性研究。数据从电子病历中检索。出院时的 SGLT2i 处方为结局。在利益相关者参与期间确定了影响 SGLT2i 处方的潜在变量，并使用多变量逻辑回归进行评估。
在 2543 名患者中，中位年龄为 79（71，86）岁，入院时 eGFR 为 38.7（28.4，49.4）mL/min/1.73 m2。630 名（24.8%）患者出院时开具了 SGLT2i。出院时开具 SGLT2i 与心血管疾病（OR 1.76，95%CI：1.31-2.35）、糖尿病（OR 1.59，95%CI：1.19-2.14）、液体超负荷或心力衰竭作为主要出院诊断（OR 1.71，95%CI：1.29-2.28）、SGLT2i 入院前（OR 104.91，95%CI：63.22-174.08）、RAS 阻滞剂（OR 2.1，95%CI：1.65-2.89）和更高的出院时 eGFR（OR 1.01，95%CI：1.003-1.02）独立相关；但与年龄较大（OR 0.97，95%CI：0.96-0.98）呈负相关。
肾功能降低患者住院治疗液体超负荷和/或心力衰竭时出院时开具 SGLT2i 的情况并不理想，尤其是在年龄较大和更严重的肾脏疾病患者中。此外，心血管疾病、糖尿病、液体超负荷或心力衰竭的主要出院诊断、SGLT2i 入院前使用以及出院时同时使用 RAS 阻滞剂与出院时开具 SGLT2i 独立相关。需要采取干预措施来提高临床医生的知识水平并克服临床惰性，以增加 SGLT2i 在有液体超负荷和心力衰竭的患者中的使用。
