Gender differences in the prescription of SGLT2 inhibitors in chronic kidney disease: A real-world database study

Chronic kidney disease (CKD) is a growing global health concern, and sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as a key treatment strategy. While their kidney-protective effects are well established in both genders, women are prescribed these agents less frequently than men for the treatment of type 2 diabetes worldwide. However, data on gender differences in SGLT2 inhibitor prescriptions for CKD remain limited.

This retrospective cohort study examined gender disparities in SGLT2 inhibitor prescriptions among individuals with CKD using a large-scale real-world database in Japan. Prescription claims data were extracted from health insurance claims records, and baseline clinical characteristics were obtained from health check-up records. CKD was defined as an eGFR <60 mL/min/1.73 m² at health checkups. Multivariable logistic regression analyses were conducted to assess the association between gender and the prescription of SGLT2 inhibitors in CKD populations.

Following the approval of SGLT2 inhibitors for CKD in late August 2021, the proportion of prescriptions increased from 0.86% to 2.10% in men and from 0.34% to 0.88% in women from September 2021 to February 2023. Multivariable logistic regression analysis identified being a woman as an independent risk factor for lower SGLT2 inhibitor prescriptions (odds ratio 0.58, 95% confidence intervals 0.55-0.62). These findings were consistent across stratified and sensitivity analyses.

Persistent gender disparities in SGLT2 inhibitor prescriptions highlight the need for healthcare providers worldwide to recognise potential gender biases and ensure equitable access to evidence-based CKD therapies. Addressing gender-based disparities is crucial for optimising CKD management globally.