Dr NICK S. R. LAN1,2,3, BEN MCFADDEN4, ANDREW JOHNSON4, PHILLIP SHEDDEN4, GERRY FEGAN5,6, HARISH PUTTAGUNTA7, SHARON HO7,8, RICHARD GILLETT4, GIRISH DWIVEDI1,2,3, RAMYASUDA SWAMINATHAN7
1Department of Cardiology, Fiona Stanley Hospital, Perth, Australia, 2Medical School, The University of Western Australia, Perth, Australia, 3Harry Perkins Institute of Medical Research, Perth, Australia, 4Patient Safety and Clinical Quality, Clinical Excellence, Department of Health, Government of Western Australia, Perth, Australia, 5Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia, 6Medical School, Curtin University, Perth, Australia, 7Department of Nephrology and Renal Transplant, Fiona Stanley Hospital, Perth, Australia, 8Department of Pharmacy, Fiona Stanley Hospital, Perth, Australia
Biography:
Nick Lan MBBS (Hons), MClinUS, MClinRes (Dist), MSc, FRACP is a Cardiologist in the Cardiometabolic Clinic at Fiona Stanley Hospital, Western Australia. He is active in research with over 80 peer-reviewed publications and has a special interest in cardiovascular-kidney-metabolic health.
Aim:
We aimed to assessereal-world prescribing of renal and cardiovascular protective medications in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).
Background:
In patients with T2D and CKD, sodium-glucose cotransporter 2 (SGLT2) inhibitors, semaglutide (glucagon-like peptide-1 [GLP-1] agonist) and finerenone (non-steroidal mineralocorticoid receptor antagonist [MRA]) have been shown to improve renal and cardiovascular outcomes. There are limited studies on real-world utilisation of these agents in patients with T2D and CKD.
Methods:
The ReDiCare project retrospectively identified patients with T2D and CKD admitted to an Australian hospital between January 2020 and September 2024 using ICD-10-AM codes. CKD was also defined as an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 for >3 months. Patients with an eGFR <15 mL/min/1.73 m², acute kidney injury, renal transplant, or those receiving dialysis were excluded. Medications prescribed at discharge were obtained.
Results: Of 2,216 patients (mean age 78.210.9 years and 41.3% female), an angiotensin converting enzyme inhibitor or angiotensin receptor blocker was prescribed in 1,243 (56.1%) patients, an SGLT2 inhibitor in 472 (21.3%), a GLP-1 agonist in 163 (7.4%) and an MRA in 305 (13.8%). Specifically, semaglutide was prescribed in 79 (3.6%) patients and finerenone in 3 (0.1%). Overall, 735 (33.2%) patients were prescribed none, 919 (41.5%) one, 433 (19.5%) two, 115 (5.2%) three and 14 (0.6%) all four medication groups. From January-March 2020 to July-September 2024, there was an increased prescribing of SGLT2 inhibitors (7.9% to 38.7%; p<0.001) and GLP-1 agonists (6.3% to 11.7%; p=0.007).
Conclusions:
In hospitalised patients with T2D and CKD, one-quarter were prescribed an SGLT2 inhibitor and/or a GLP1 agonist at discharge. Implementation studies should identify whether uptake of cardio-renal protective therapies can be optimised.