Dr Tamara Milder1,2,3,4, Dr SOPHIE STOCKER3,5, Prof MELISSA BAYSARI6, Prof RICHARD DAY2,3, Prof JERRY GREENFIELD1,3,4
1Department of Endocrinology and Diabetes, St Vincent’s Hospital, Sydney, Australia, 2Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney, Australia, 3School of Clinical Medicine, St Vincent’s Clinical Campus, UNSW Sydney, Sydney, Australia, 4Healthy Ageing, Garvan Institute of Medical Research, Sydney, Australia, 5School of Pharmacy, The University of Sydney, Sydney, Australia, 6Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
Aim: To explore with Nephrologists and Cardiologists their perspectives regarding prescribing SGLT2 inhibitors (SGLT2i) to patients with chronic kidney disease (CKD).
Background: SGLT2i have reno- and cardioprotective benefits in people with CKD independent of their anti-hyperglycaemic effects.
Methods: Semi-structured interviews were conducted with 12 Nephrologists and 12 Cardiologists working in diverse areas in New South Wales. Purposive and snowball approaches were used to recruit participants. Emergent themes were identified from transcripts. Interviews were conducted until thematic saturation was reached.
Results: Nephrologists were generally comfortable prescribing SGLT2i to patients with diabetes and CKD. If a patient was under the care of an Endocrinologist, many Nephrologists preferred to check the prescription with the Endocrinologist prior to initiation. Whilst several Nephrologists had prescribed SGLT2i to patients without diabetes, the lack of a Pharmaceutical Benefits Scheme (PBS) CKD indication for SGLT2i was a major barrier to prescribing SGLT2i to this patient group. There was variability amongst Nephrologists regarding the minimum estimated glomerular filtration rate that is acceptable for commencing SGLT2i, and the timing of renal function monitoring after SGLT2i initiation in patients with CKD. This latter point, in part, reflected differences in concern about the risk of volume depletion. Non-Heart Failure Subspecialist Cardiologists were less comfortable compared with Nephrologists prescribing SGLT2i to patients with advanced CKD.
Conclusions: The lack of a PBS CKD indication is an important factor preventing Nephrologists prescribing SGLT2i to patients without diabetes. Nephrologists have a role in reassuring Cardiologists and other specialists about prescribing SGLT2i to patients with more advanced CKD. Additionally, there is a need for clear, specific guidance about prescribing SGLT2i in patients with renal dysfunction and renal function monitoring after SGLT2i initiation.
Biography:
Dr Tamara Milder is an Endocrinologist, who is undertaking a PhD through UNSW Sydney about sodium-glucose cotransporter 2 (SGLT2) inhibitors. Her PhD explores the effective and safe use of these agents. Tamara is supervised by Prof Jerry Greenfield and Prof Richard Day.