Abstract Background Chronic kidney disease (CKD) represents a substantial global health burden, affecting approximately 10% of the population and profoundly heightening the risk of cardiovascular morbidity and mortality. Although renin-angiotensin system inhibitors constitute historically a fundamental treatment, emerging evidence highlights the additional renoprotective benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and finerenone in slowing CKD progression and mitigating cardiovascular events. Aims This study aimed to evaluate the real-world utilization of guideline-directed medical therapy (GDMT) among patients with cardiorenal morbidity in Greece and identify factors associated with its prescription trends. Methods In this analysis of the Hellenic Cardiorenal Morbidity Snapshots (HECMOS1 and 2), we enrolled all Cardiology inpatients being hospitalized on the March 3, 2022 and June 5, 2024 respectively across Greece. Self-reported patient comorbidities and medical therapy were recorded. CKD patients eligible for SGLT2i and finerenone therapy were identified based on guideline criteria, and prescription patterns were analyzed. Multivariable logistic regression assessed predictors of SGLT2i usage. Results Chronic kidney disease (CKD) was documented in 26% and 27% of the HECMOS 1 and 2 cohorts, respectively. The utilization of SGLT2 inhibitors prior to the index admission was reported in 15% of the CKD population in HECMOS 1, whereas in the HECMOS 2 cohort, the prevalence rose to 30.4%. In HECMOS 1, compared to non-users, SGLT2i users were younger (73.7 (10.3) years vs. 78.0 (10.0) years, p=0.03) and the vast majority had DM (90.6% vs. 47.5%, p0.001) (Figure 1). At the same time, they commonly had a history of CHF (93.8% vs. 73.1%, p=0.01) and ASCVD (69.7 vs. 49.2, p=0.03). SGLT2i users were predominantly patients with coexisting CHF and were receiving diuretics and MRAs at higher frequency in HECMOS 2. Interestingly, consultation with a nephrologist did not appear to influence SGLT2i prescription rates. Multivariable analysis showed that the history of DM was the most important predictor of SGLT2i usage in HECMOS 1 (OR: 12.01, 95% CI: 3.31-45.56, p0.001), while history of CHF was significantly associated with SGLT2i use (OR: 4.10, 95% CI: 1.70-9.88, p=0.002) in HECMOS 2 (Figure 2). Regarding finerenone, only 1.7% of patients were on such treatment prior to the index hospitalization in HECMOS 2. Conclusion Despite proven efficacy, GDMT remain underutilized in eligible CKD patients, indicating significant physician inertia. Addressing this gap through targeted educational initiatives and support tools is essential for optimizing CKD management and improving patient outcomes.Figure 1 Figure 2
Theofilis et al. (Sat,) studied this question.