Exton, PA, May 13, 2026 (GLOBE NEWSWIRE) -- Nephrologists are initiating SGLT2 inhibitors earlier in the chronic kidney disease (CKD) treatment journey and continuing them well below labeled eGFR thresholds. At the same time, real-world uptake of GLP-1 agonists continue to lag behind rising expectations for cardiorenal outcomes. These findings, based on chart audit data from 1,052 patient records submitted by 180 U.S. nephrologists come from the latest Patient Chart Dynamix™: Chronic Kidney Disease, Non-Dialysis (US) service from Spherix Global Insights and highlight a field that has firmly repositioned SGLT2 inhibitors as foundational therapy, while remaining divided on the role of GLP-1s.
SGLT2 inhibitor use is expanding well beyond its traditional diabetic kidney disease (DKD) anchor. Use has reached nearly two-thirds of patients with type 2 diabetes and roughly one-third of non-diabetic CKD patients, with adoption broadening across a wider CKD patient mix. Nephrologists were most often the initial prescriber, and a clear majority of initiations are concentrated in CKD Stage 3. The clinical profile suggests clinicians are starting therapy in moderately impaired patients not soley defined by uncontrolled glycemia — positioning SGLT2 inhibitors as foundational kidney and cardiovascular interventions rather than a last-resort glucose strategy.
Within this evolving landscape, brand dynamics are diverging. Farxiga (dapagliflozin, AstraZeneca) leads the field — capturing the stated preference of nearly half of physicians and the majority of new SGLT2 prescriptions at the most recent visit. Jardiance (empagliflozin, Boehringer Ingelheim/Lilly), buoyed by its 2022 CKD label expansion, captured nearly one-third of stated preference and continues to gain share in non-DKD CKD.
In advanced CKD scenarios, nephrologists report a willingness to continue SGLT2 inhibitors even as kidney function declines below thresholds that historically prompted caution: the average stated eGFR threshold for discontinuation was 14.1 mL/min, with few nephrologists reporting intentions to stop therapy even as patients' eGFR falls below 20 mL/min. This suggests clinicians perceive continued benefit despite labeling constraints, with many anticipating further uptake as generic SGLT2 inhibitors enter the market.
Alongside this expanding SGLT2 footprint, GLP-1 agonists tell a different story. Nephrologists are increasingly focused on renal and cardiovascular outcomes rather than weight loss — reflecting a broader shift in how the drug class is being evaluated in the CKD population. Comfort with initiating GLP-1 agonists rose meaningfully in 2025, as two-thirds now describe themselves as extremely comfortable with using them in DKD patients, while half say the same for their non-DKD patients. Utilization, however, remains selective. Nearly one-third cited lack of perceived benefit as the primary barrier to prescribing, and one-quarter cited patient population — specifically, patients without diabetes — as a reason not to prescribe, highlighting the gap between prescribing comfort and perceived clinical value.
Among current GLP-1 prescriptions, Ozempic (semaglutide, Novo Nordisk) accounted for more than half of use, followed by roughly one in five for Mounjaro (tirzepatide, Lilly), with Trulicity (dulaglutide, Lilly), Wegovy (semaglutide, Novo Nordisk), and Rybelsus (semaglutide, Novo Nordisk) trailing. Mean labs at initiation show GLP-1s are deployed in moderate CKD with elevated glycemic markers. A majority of treated patients lost weight, averaging roughly 10 lbs., though persistence of that weight loss varied markedly by molecule — Mounjaro and Wegovy exceeded one year on average, while Ozempic, Trulicity, and Rybelsus trailed progressively behind.
Kari McCarthy, nephrology franchise head at Spherix Global Insights, pointed to the access and persistence challenges facing those nephrologists who do see a role for GLP-1s in CKD:
"Nephrologists are increasingly interested in the cardiorenal potential of GLP-1s in CKD, but real-world use remains constrained by eligibility, access, and patient persistence. Closing that gap will require clearer signals on who to treat, improved access, and evidence that translates into routine practice."
The findings also signal early movement around emerging assets that could reshape the cardiorenal metabolic toolkit. Nephrologists report willingness to use rilparencel (ProKidney) and modest but growing familiarity with Tryvio (aprocitentan, Idorsia). Kerendia (finerenone, Bayer) now accounts for nearly half of MRA prescriptions in CKD-ND patients —and is increasingly viewed as a core therapy in both diabetic and non-diabetic CKD — with spironolactone making up the bulk of the remainder.
The 2025 data capture a field in transition. SGLT2 inhibitors have been recast as foundational cardiorenal therapy and are being used earlier and longer than labels suggest, while GLP-1 agonists remain contested — embraced by some nephrologists as the next frontier in kidney and cardiovascular protection, and viewed skeptically by others. Looking ahead, as additional data, guideline updates, and real-world experience accumulate over the next 12–18 months, stakeholders will be watching whether confidence and access for GLP-1s expand, and whether the earlier initiation and ether emerging SGLT2 treatment patterns become standardized across care settings.
About Patient Chart Dynamix™
Patient Chart Dynamix™ is an independent, data-driven service unveiling real patient management patterns through rigorous analysis of large-scale patient chart audits. Insights reveal the “why” behind treatment decisions, include year-over-year trending to quantify key aspects of market evolution, and integrate specialists’ attitudinal and demographic data to highlight differences between stated and actual treatment patterns.
About Spherix Global Insights
Spherix Global Insights is a leading independent provider of market intelligence and advisory services for specialty pharmaceutical and biotech markets. By combining physician, patient, and payer perspectives into a single integrated view, Spherix helps brand teams, market access stakeholders, and investors understand how a specialty market actually behaves, not how any one stakeholder describes it. The firm operates eight dedicated therapeutic franchises – Central Nervous System, Dermatology, Gastroenterology, Hematology, Nephrology, Oncology, Ophthalmology, and Rheumatology – alongside a fully dedicated Market Access team. Each franchise is led by hyper-focused analysts and researchers who track these specialty areas full-time, drawing on independently curated communities of vetted practicing specialists, KOLs, patients recruited through treating physicians and advocacy partners, and medical and pharmacy directors at commercial and government payers. Spherix delivers quarterly trending, launch tracking, chart audits, KOL synthesis, patient experience research, and payer and market access intelligence that support confident, strategic decision-making across the pharma lifecycle. Trusted by 19 of the top 20 pharmaceutical and biotech organizations, Spherix has been a go-to resource for more than a decade for leading brands, market access stakeholders, industry media outlets, financial analysts, professional organizations, and patient advocacy groups seeking an unbiased, holistic view of specialty markets.
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Kari McCarthy Spherix Global Insights 484-879-4284 kari.mccarthy@spherixglobalinights.com
