Practical tips for implementing SGLT2i in practice

As life expectancy increases so does the burden of chronic kidney disease (CKD) and interrelated cardiovascular (CV) and metabolic comorbidities, highlighting the importance of guideline-directed medical therapy to reduce the likelihood of CKD progression and the development of cardiovascular disease (CVD) in individuals with CKD. Recent changes in the treatment landscape for CKD, in particular the approval of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for patients with CKD for cardiorenal protection, are reflected in current clinical practice guidelines. The Kidney Disease Improving Global Outcomes (KDIGO, 2024) guidelines support the use of SGLT2i in most subgroups of patients with CKD for the prevention of CKD progression, CV death, or death from any cause. However, uptake of SGLT2i has been slow in practice. Barriers to implementation of SGLT2i can be overcome through a range of measures, including addressing patient concerns and misconceptions about treatment, and developing policies aimed at mitigating the costs associated with therapy. The KDIGO guidelines emphasize the importance of collaboration between healthcare professionals and pharmacists to help patients understand and manage their medication regimens, including reporting adverse events so that they can be appropriately managed. A holistic approach to the care of patients with CKD should incorporate lifestyle advice, risk factor management, and education of patients and caregivers. In addition, ensuring that physicians stay up to date on changing advice on best practices and facilitating early appropriate referral to a nephrologist is crucial in ensuring that patients who will benefit most from SGLT2i are evaluated and treated promptly. This approach can help to manage modifiable risk factors, improve access to SGLT2i, support treatment adherence, and ultimately improve outcomes for patients with CKD.