Estimating the population-level impacts of improved uptake of SGLT2 inhibitors in patients with chronic kidney disease: a cross-sectional observational study using routinely collected Australian primary care dataResearch in context

Brendon L. Neuen; Min Jun; James Wick; Sradha Kotwal; Sunil V. Badve; Meg J. Jardine; Martin Gallagher; John Chalmers; Kellie Nallaiah; Vlado Perkovic; David Peiris; Anthony Rodgers; Mark Woodward; Paul E. Ronksley

The Lancet Regional Health. Western Pacific (Feb 2024)

Estimating the population-level impacts of improved uptake of SGLT2 inhibitors in patients with chronic kidney disease: a cross-sectional observational study using routinely collected Australian primary care dataResearch in context

Brendon L. Neuen,
Min Jun,
James Wick,
Sradha Kotwal,
Sunil V. Badve,
Meg J. Jardine,
Martin Gallagher,
John Chalmers,
Kellie Nallaiah,
Vlado Perkovic,
David Peiris,
Anthony Rodgers,
Mark Woodward,
Paul E. Ronksley

Affiliations

Brendon L. Neuen: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia; Corresponding author. The George Institute for Global Health, Level 5, 1 King St Newtown, New South Wales 2042, Australia.
Min Jun: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia
James Wick: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Sradha Kotwal: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Nephrology, Prince of Wales Hospital, Sydney, Australia
Sunil V. Badve: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Renal Medicine, St George Hospital, Sydney, Australia
Meg J. Jardine: NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia; Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
Martin Gallagher: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Renal Medicine, Liverpool Hospital, Sydney, Australia
John Chalmers: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia
Kellie Nallaiah: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia
Vlado Perkovic: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
David Peiris: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia
Anthony Rodgers: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia
Mark Woodward: Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
Paul E. Ronksley: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Journal volume & issue: Vol. 43
p. 100988

Abstract

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Summary: Background: Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of kidney failure and death in patients with chronic kidney disease (CKD) but are underused. We evaluated the number of patients with CKD in Australia that would be eligible for treatment and estimated the number of cardiorenal and kidney failure events that could be averted with improved uptake of SGLT2 inhibitors. Methods: This cross-sectional observational study leveraged nationally representative primary care data from 392 Australian general practices (MedicineInsight) between 1 January 2020 and 31 December 2021. We identified patients that would have met inclusion criteria of key SGLT2 inhibitor trials and applied these data to age and sex-stratified estimates of CKD prevalence for the Australian population (using national census data), estimating the number of preventable events using trial event rates. Key outcomes included cardiorenal events (CKD progression, kidney failure, or death due to cardiovascular or kidney disease) and kidney failure. Findings: In MedicineInsight, 44.2% of adults with CKD would have met CKD eligibility criteria for an SGLT2 inhibitor; baseline use was 4.1%. Applying these data to the Australian population, 230,246 patients with CKD would have been eligible for treatment with an SGLT2 inhibitor. Optimal implementation of SGLT2 inhibitors (75% uptake) could reduce cardiorenal and kidney failure events annually in Australia by 3644 (95% CI 3526–3764) and 1312 (95% CI 1242–1385), respectively. Interpretation: Improved uptake of SGLT2 inhibitors for patients with CKD in Australia has the potential to prevent large numbers of patients experiencing CKD progression or dying due to cardiovascular or kidney disease. Identifying strategies to increase the uptake of SGLT2 inhibitors is critical to realising the population-level benefits of this drug class. Funding: University of New South Wales Scientia Program and Boehringer Ingelheim Eli Lilly Alliance.

Published in The Lancet Regional Health. Western Pacific

ISSN: 2666-6065 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanwpc/home

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