SGLT2 Inhibitor Use in Chronic Kidney Disease
Promotes evidence-based prescribing of SGLT2 inhibitors in patients with chronic kidney disease stages 2-3. SGLT2 inhibitors have been shown to slow CKD progression and reduce cardiovascular events regardless of diabetes status.
Measure Rationale
SGLT2 inhibitors represent a paradigm shift in the management of chronic kidney disease. Multiple landmark trials have demonstrated their ability to significantly reduce the risk of CKD progression, cardiovascular events, and hospitalization for heart failure—benefits that extend to patients without diabetes. Despite strong evidence and guideline recommendations, adoption in clinical practice remains suboptimal.
Measure Specification
All patients aged 18 years and older with a diagnosis of chronic kidney disease stages 2-3 (eGFR 30-89 mL/min/1.73m²) with or without type 2 diabetes.
Denominator Note:
Chronic kidney disease is identified through diagnosis codes and laboratory values indicating reduced kidney function.
Patients with contraindications to SGLT2 inhibitor therapy, including type 1 diabetes, history of diabetic ketoacidosis, or severe hepatic impairment.
Performance Met:
Patient is prescribed an SGLT2 inhibitor or documentation of shared decision-making discussion regarding SGLT2 inhibitor therapy.
Performance Not Met:
Patient is not prescribed an SGLT2 inhibitor and no documentation of shared decision-making discussion.
Patients who were first started on guideline-directed medical therapy (GDMT) within 6 months of the repeat echocardiogram. GDMT must include the following 3 medication classes: • ARNI or ACE or ARB • SGLT2-inhibitor • Beta Blocker
Clinical Recommendation Statement
KDIGO 2024 guidelines recommend SGLT2 inhibitors for patients with CKD regardless of diabetes status. The ADA Standards of Care recommend SGLT2 inhibitors for patients with diabetes and CKD to reduce CKD progression and cardiovascular events.
References
- 1.
Heerspink HJL, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383:1436-1446.
- 2.
KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024.
- 3.
American Diabetes Association. Standards of Care in Diabetes—2024. Diabetes Care. 2024.
Use this measure in your practice
This measure is available through VBCA's CMS-approved QCDR. First and second-year measures receive automatic MIPS points regardless of performance.