Ask your doctor about SGLT-2 inhibitors

Chronic kidney disease represents a broad group of patients, ranging from those at risk of kidney disease (CKD 1) to those with advanced decline in kidney function (CKD 5). Whatever their stage, the ultimate goal in CKD treatment is to preserve kidney function as much as possible. Ultimately, this keeps patients out of the hospital and off dialysis.

Today, there are a few important prescription drugs we can employ in the fight against CKD. ACE and ARB inhibitors already help preserve kidney function in CKD patients, but recently another type of drug has emerged as a champion in the fight against kidney disease. Its results are simply too good to be ignored.

If you have been diagnosed with CKD, you should ask your doctor about taking an SGLT-2 inhibitor. These drugs include Invokana (Vifor (Relypsa)/Janssen), Farxiga (AstraZeneca), Jardiance (Eli Lilly/Boehringer Ingelheim), and Steglatro (Merck).

Today, we’ll hear from nephrologist Richard Gibney, MD to get some background and questions you can ask your doctor to be empowered to take control of your own healthcare journey…

How do prescription drugs help manage CKD?

Several prescription drugs help treat some of the underlying risk factors for kidney disease and help preserve kidney function at the same time. ACE and ARBs were originally blood pressure medication, but soon after they came out, doctors noticed a significant reduction of kidney incidents as well.

SGLT-2 inhibitors came out initially as a diabetic drug, but doctors realized they had a protective effect for kidney disease too. It’s a great drug to help the heart pump better and get rid of excess fluid. If we combine this drug with lifestyle changes, we can preserve—or certainly slow down—the loss of kidney function. It’s totally a game changer.

Now SGLT-2s are not just for diabetics, they are beneficial for anyone with a decrease in kidney function and the potential to get worse.

We’ve set our sights high. We’re going for the best possible results… hopefully this drug is effective enough that we’d never put a new person on dialysis again.

Are SGLT-2s available to everyone?

While SGLT-2s are widely available, many patients still face significant financial challenges to receiving the drug.

Here in Texas, the drug costs $17 per daily tablet. That’s basically $600 per month, which is a huge expense. This is a problem for many patients, and other doctors might dismiss it as an option if they think it’s too expensive. That’s a barrier in the system.

How can we get more SGLT-2s to people who need them the most? It’s up to both patients and doctors to ask questions and demand solutions. Here at my hospital, I went to the business office and told them that my patients needed this drug, and that $17 was simply unacceptable. They worked their magic and found various grants, opportunities, and special programs… now they’ve gotten the cost down to just a penny per tablet—30 cents a month for a drug with tremendous potential!

We’re now putting together a program where the nephrologists, endocrinologists, and cardiologists are all enthusiastic about this, but the most thrilling part is a collaboration with primary care providers (PCPs). We want to get a better understanding of CKD to the front lines where doctors can identify risk and present options like SGLT-2s long before a problem develops.

Why aren’t more CKD patients taking the right prescriptions?

CKD represents a big gap in American healthcare. CKD patients are notoriously underserved and uninformed. In fact, data from Centers for Medicare and Medicaid Services (CMS) shows that 92% of patients with CKD stage 1-3 are unaware that they even have kidney problems.

Whose “job” is it to treat and slow the progression of CKD? Many nephrologists are hesitant to address kidney disease risk factors like diabetes, leaving that to PCPs. Those doctors; however, are often hesitant to act on specialized kidney issues. This communication breakdown is nothing but bad news for patients. Left unchecked, CKD can quickly progress to kidney failure.

ACE and ARBs have already been around for 20 years, and today they are still only prescribed to 50% of the people who should be taking them. We don’t want the same thing to happen with SGLT-2s as well.

What can I do to get an SGLT-2 prescription?

If you have been diagnosed with CKD or are at risk for kidney disease (diabetes, hypertension), ask your doctor about SGLT-2s. The evidence is out there, this is a major benefit for optimizing care, delivering results, and ultimately reducing healthcare costs.

If it’s too expensive, don’t take “no” for an answer. Doctors need to advocate for SGLT-2s. Together, we can make it potentially cost-friendly and get that barrier removed.

You are not alone! There are many great doctors out there who will be happy to answer your questions and help get you results. Surround yourself with the right resources, the right healthcare professionals, and fellow patients who are experiencing a similar journey.

Remember that we’re all in this together as a team, trying to protect and help each other. We’re flipping the whole scenario from a pursuit of treating disease to the pursuit of keeping people healthy.