OBJECTIVES: To compare adherence and persistence with sodium-glucose-cotransporter-2 inhibitors (SGLT2i) between White and Black diabetic kidney disease (DKD) patients in a US claims database.

METHODS: Adult (18+) DKD patients treated with a first SGLT2i (index) between January 1, 2018 and June 30, 2022 were identified in CHRONOS, a linked claims and social determinants of health (SDoH) database. Patients had incident stage 3 or 4 chronic kidney disease, a history of diabetes, and 12 months continuous enrollment in the year before index. Adherence and persistence in the year after index were calculated using proportion of days covered (PDC) defined by dividing total days supply of SGLT2i between index and the last dispensing by total days of follow-up. Patients were censored if switching to a new drug class but allowed to switch between SGLT2i. Adherence was defined as PDC ≥ 80% and persistence as continuous medication coverage, without gaps, until end of follow-up. Logistic regression compared outcomes between White and Black patients, adjusting for demographics, baseline characteristics, and SDoH. Adjusted odds ratios and 95% confidence intervals are reported. All patient characteristics were defined by ICD-10-CM and NDC codes.

RESULTS: White (n=1,294) and Black (n=231) patients initiating an SGLT2i were 37% and 48% female with a mean age of 60.4 (SD:7.1) and 56.9 (SD:7.9). Adherence and persistence were met by 85% and 44% of White patients and 78% and 37% of Black patients, respectively. White patients were 1.4 (1.1-2.1) and 1.4 (1.0-1.9) times as likely as Black patients to meet the definitions of adherence and persistence.

CONCLUSIONS: In this analysis, White patients with DKD were more likely than Black patients to be defined as adherent and persistent with SGLT2i. As the use of SGLT2i to slow the progression of kidney disease becomes increasingly common, healthcare stakeholders should take action to reduce disparities between White and Black patients.