Real-world Practice Patterns and Barriers to SGLT2 Inhibitor Use: A Nationwide Survey of Japanese General Practitioners

Introduction: Sodium-glucose cotransporter 2 (SGLT2) inhibitors were approved for the treatment of chronic kidney disease (CKD) in Japan in 2021. However, their use remains limited, and broader implementation is necessary to improve CKD outcomes. Methods: A questionnaire survey on the diagnosis and treatment of CKD was conducted among members of the Japan Physicians Association and local internal medicine associations. Based on responses regarding the use of SGLT2 inhibitors in patients with CKD, respondents excluding nephrologists were classified into two groups: the Active User group (n = 508) and the Passive User group (n = 316). The responses were compared between groups, and independent factors associated with active use were analyzed using logistic regression analysis. Results: Compared with the Passive User group, respondents in the Active User group were younger (p = 0.047). Specialization in cardiology, allergy, use of serum cystatin C to evaluate kidney function, utilization of urine testing, use of estimated glomerular filtration rate and kidney imaging to define CKD, frequent assessment of quantitative albuminuria, evaluation of hemoglobin and transferrin saturation levels to assess renal anemia, prescription of hypoxia-inducible factor prolyl hydroxylase inhibitors, implementation of dietary therapy for patients with non-dialysis CKD, referral to nephrologists for both proteinuria and hematuria, and consultation for proteinuria >1.0 g/gCr or ≥2+ by qualitative testing were all positively associated with the Active User group, with odds ratios of 1.84, 6.13, 2.05, 34.8, 1.96, 4.52, 1.72, 2.10, 2.56, 2.03, and 2.62, respectively. Conclusions: Among non-nephrologists, difference in the active prescription of SGLT2 inhibitors for patients with CKD was associated with a comprehensive and guideline-based approach to CKD management.