Persistent gender differences in the management of chronic kidney disease in patients with heart failure – follow-up of the InspeCKD study

Background / Introduction Chronic kidney disease (CKD) is one of the most prevalent comorbidities in patients with heart failure (HF). Guidelines provide recommendations regarding screening of patients at risk for CKD and early intervention with sodium-glucose cotransporter-2 inhibitors (SGLT2i) to improve HF and kidney outcomes. Current data of the InspeCKD study revealed substantial gaps in laboratory diagnostics and therapy of CKF in German primary care, especially of women with HF. Aims The purpose of this follow-up analysis (study period 01/2023-12/2024) was to investigate if and to which extend CKD management of HF patients has changed since the first reporting period (06/2020-06/2023). Methods Electronic, fully anonymized patient data from 1,832 German primary care practices were evaluated. Applying current screening recommendations, adult patients with hypertension, diabetes, and/or cardiovascular disease, including HF, were included in the study. Individual observation period was ~1.7 years. Results Baseline characteristics of HF patients were comparable between both study periods. Serum creatinine to estimate glomerular filtration rate (eGFR) was measured at least once in 48.5% of HF patients during the first reporting period, compared to 55.2% of HF patients in the current study period. Testing for albuminuria by determining urine albumin-to-creatinine ratio (UACR) increased from 0.3% of HF patients in the first reporting period to 1.5% of HF patients in the current study period. Women were less often screened for albuminuria (UACR: 1.3% women vs. 1.8% men). The proportion of HF patients diagnosed with CKD and treated with the recommended combination of a renin-angiotensin system inhibitor (RASi) and SGLT2i within six months after CKD diagnosis increased from 14.1% in the first reporting period to 33.0% in the current study period. Women with HF and CKD were still less likely to be treated with RASi+SGLT2i (first study period: 10.7% women vs. 18.0% men; current study period: 27.1% women vs. 39.4% men). Conclusion(s) The follow-up analysis of the InspeCKD study reveals slight improvements in screening, notably in the determination of UACR, of HF patients at risk for CKD. However, a substantial proportion of HF patients, including both men and women, does not receive adequate laboratory diagnostics for early detection of CKD. The proportion of HF patients diagnosed with CKD receiving guideline-directed medical therapy (GDMT) with RASi+SGLT2i increased by 2.3-fold. Nonetheless, the majority of HF patients with diagnosed CKD, and women in particular, does not receive GDMT, despite a KDIGO 1A recommendation to treat adults with CKD and HF with SGLT2i, irrespective of level of albuminuria. In summary, the analysis underlines the need to optimize CKD awareness and clinical management for HF patients in German primary care, while also addressing gender-specific differences in CKD care.