Real-World Prescribing of Renal and Cardiovascular Protective Drugs in Patients With Type 2 Diabetes and Chronic Kidney Disease: Analysis of Data From a Western Australian Quaternary Hospital.

Background: In patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), sodium-glucose cotransporter 2 (SGLT2) inhibitors, semaglutide (glucagon-like peptide-1 [GLP-1] agonist), and finerenone (non-steroidal mineralocorticoid receptor antagonist) improve renal and cardiovascular outcomes. We assessed real-world prescribing of these drugs in patients with T2D and CKD.

Method: The ReDiCare project retrospectively identified patients with T2D and CKD admitted to an Australian hospital between January 2020 and September 2024 using International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification codes. CKD was also defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m for >3 months. Patients with an eGFR <15 mL/min/1.73 m, acute kidney injury, renal transplant, or those receiving dialysis were excluded. Drugs prescribed at discharge were obtained.

Results: Of 2,216 patients (mean age 78.2±10.9 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 a mineralocorticoid receptor antagonist in 305 (13.8%). Specifically, semaglutide was prescribed in 79 (3.6%) patients and finerenone in three (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 drug groups. From January to March 2020 to July to September 2024, there was an increased prescribing of SGLT2 inhibitors (7.9%-38.7%; p<0.001) and GLP-1 agonists (6.3%-11.7%; p=0.007).

Conclusions: In patients admitted to the hospital with T2D and CKD, one-quarter were prescribed an SGLT2 inhibitor and/or a GLP-1 agonist at discharge. Further studies are required to identify barriers and enablers to prescribing these drugs.