Kidney specialists are underleveraging powerful tools. While 73% of endocrinologists prescribe glucose-lowering medications, fewer than 10% of nephrologists do — despite seeing high-risk patients most frequently. New data support SGLT2 inhibitors and GLP-1 receptor agonists as a powerful combination for managing cardiovascular-kidney-metabolic (CKM) syndrome, and experts say nephrologists are uniquely positioned to lead the charge.
Kidney doctors are sitting on an untapped opportunity. A striking prescribing gap has emerged in CKM syndrome care: 73% of endocrinologists prescribe glucose-lowering medications, yet fewer than 10% of nephrologists do — even though patients with advanced kidney disease see their nephrologist more often than any other specialist. With a projected shortage of up to 40,400 primary care physicians by 2036 and nearly 70% of counties lacking endocrinologist access, nephrologists are well-placed to fill this void.
The clinical case for acting is strong. SGLT2 inhibitors and GLP-1 receptor agonists work through complementary mechanisms and together offer CV risk reduction, kidney protection, and weight management. Yet among Medicare beneficiaries with stage 4–5 CKD in 2023, only 15.7% received SGLT2 inhibitors and 13.8% received GLP-1 medications.
By the Numbers:
Why it matters: Cardiovascular disease — not kidney failure — is the leading cause of death in CKD patients. Nephrologists who proactively prescribe these therapies and advocate for broader access could dramatically shift outcomes for one of medicine's most vulnerable populations.
