Indications for sodium–glucose cotransporter 2 inhibitors in adults with diabetes, focusing on chronic kidney disease*
| Indication | No. of adults with the indicated condition (proportion of all adults with diabetes) | No. of SGLT2 inhibitor users (proportion of SGLT2 inhibitor users, out of adults with the specified indication) |
|---|---|---|
| All adults with diabetes | 446 315 (100.0) | 33 788/446 315 (7.6) |
| Adults with chronic kidney disease eligible for SGLT2 inhibitors | ||
| (A) Chronic kidney disease stage ≥ 2† and at least severe proteinuria | 12 867 (2.9) | 988/12 867 (7.7) |
| (B) Chronic kidney disease stage ≥ 3† or at least moderate proteinuria | 76 630 (17.2) | 5460/76 630 (7.1) |
| Other conditions indicating SGLT2 inhibitor treatment (cardiovascular disease and heart failure) | ||
| Cardiovascular disease + heart failure | 126 453 (28.3) | 11 037/126 453 (8.7) |
| Cardiovascular disease + heart failure + chronic kidney disease | 165 617 (37.1) | 13 545/165 617 (8.2) |
Note: eGFR = estimated glomerular filtration rate, KDIGO = Kidney Disease: Improving Global Outcomes, SGLT2 = sodium–glucose cotransporter 2.
↵* Two definitions of chronic kidney disease were considered, labelled (A) and (B). Indication (A) is a subset of (B). Indication (A) reflects trial inclusion criteria of the CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) and DAPA-CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease) trials, and indication (B) reflects a broader definition of chronic kidney disease for SGLT2 inhibitor eligibility adopted in the Diabetes Canada and KDIGO (Kidney Disease: Improving Global Outcomes) diabetic kidney disease guidelines. Cardiorenal benefits have been shown in kidney trials enrolling adults meeting criteria (A). Regarding criteria (B), cardiorenal benefits are extrapolated from the kidney trials and have also been shown directly in subgroup analyses of cardiovascular trials showing renal benefit in adults with chronic kidney disease not meeting criteria (A).
↵† Chronic kidney disease stage ≥ 2 refers to eGFR < 90 mL/min/1.73 m2. Chronic kidney disease stage ≥ 3 refers to eGFR ≥ 30 and < 60 mL/min/1.73 m2.