WHY ARE PATIENTS WITH IGA NEPHROPATHY NOT ON SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS – A SINGLE CENTRE RETROSPECTIVE REAL-WORLD STUDY
Dr Mohammad Alamein1, DR DARREN LEE2
1Austin Health, Heidelberg, Australia, 2Eastern Health, Box Hill, Australia
Aim: To assess the real-world experience of adherence to optimal standard-of-care with angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) in immunoglobulin A nephropathy (IgAN).
Background: SGLT2i have been demonstrated to improve kidney outcomes in IgAN. On 1 September 2002, dapagliflozin was Pharmaceutical Benefits Scheme (PBS) listed for chronic kidney disease on the maximum tolerated dose of ACEi/ARB.
Methods: A single-centre retrospective audit of patients with IgAN (01/01/2009-31/03/2021) was undertaken using the key word search “Oxford classification” from kidney biopsy reports. PBS eligibility (eGFR 25-75ml/min/1.73m2 and urine ACR 22.6–565mg/mmol) and ACEi/ARB and/or SGLT2i use were assessed in January 2022 (3 months after Therapeutic Goods Administration approval), December 2022 (3 months after PBS listing), March 2023 and June 2023.
Results: Of the 151 patients identified, 106 were excluded due to external follow-up (n=55), commencing kidney replacement therapy or dying prior to December 2022 (n=26), no clinical record (n=19), lost to follow-up (n=5) and co-existing histopathology (n=1). Of the remaining 45 patients, ACEi/ARB use increased from 71% in January 2022 to 87% in June 2023. SGLT2i uptake increased from 7% in January 2022 to 24% in December 2022 but remained static in June 2023 at 27% (n=12). 23 patients did not meet PBS criteria, primarily due to inadequate albuminuria (n=17). Of the remaining 10 who fulfilled PBS criteria, reasons for not prescribing SGLT2i included loss to follow-up (n=4), ACEi/ARB not maximised (n=3), pregnancies (n=2) and previous lack of response (n=1).
Conclusions: PBS listing of dapagliflozin has facilitated an increase in SGLT2i use in IgAN. This, however, remained under-utilised primarily due to PBS restrictions, limiting the potential benefits in a wider population.
Biography:
Mohammad is a third-year nephrology advanced trainee at Austin Health. He holds a PhD in stem cells and tissue engineering. His interests are dialysis and CKD.