Abstract: TH-PO1025
Predictors and Outcomes of Discontinuation of Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2is) in CKD
Session Information
- CKD Epidemiology, Risk Factors, Prevention - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
- Richardson, Peter, Michael E DeBakey VA Medical Center, Houston, Texas, United States
- Nambi, Vijay, Baylor College of Medicine, Houston, Texas, United States
- Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Virani, Salim S., The Aga Khan University, Karachi, Sindh, Pakistan
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background
SGLT2is decrease the progression of CKD and improve cardiovascular outcomes. However, their utilization remains low. Little is known about treatment discontinuation and its associations with patient characteristics and outcomes.
Methods
We identified adults with CKD stages 3-4 receiving care at Veterans Affairs (VA) facilities from 2005-2022 from the VA Corporate Data Warehouse. Individuals who had an incident prescription for an SGLT2i were included, with the date of prescription considered the index date. The primary outcome was treatment discontinuation, defined as an interruption in SGLT2i prescription for at least 90 days. Cox proportional hazards regression identified factors associated with time to treatment discontinuation. Cox proportional hazards regression treating SGLT2i discontinuation as a time-varying covariate assessed the association of treatment discontinuation with time to all-cause death.
Results
Of 96,345 individuals who received an SGLT2i, 97% were male, 71% were White, 24% were Black, 71% were age ≥70, and 84% had CKD stage 3a. Discontinuation (at least once) occurred in 35,953 (37%) SGLT2i users over a median (IQR) of 1.01 (0.58, 1.74) years of follow up. Black race, female sex, younger age, and more advanced stage of CKD were associated with SGLT2i discontinuation (Figure). There were 8698 deaths. SGLT2i discontinuation, included as a time-varying covariate, was associated with all-cause death (HR 1.57 [95% CI 1.49, 1.66], P<0.0001) independent of age, sex, race, CKD stage, medical comorbidities, and concomitant medication use.
Conclusion
Discontinuation of SGLT2is is common and is associated with an increased risk of mortality. Further studies to understand the reasons for SGLT2i discontinuation (both temporary and permanent), and additional efforts to improve adherence are warranted.
Funding
- Other NIH Support