Sodium-Glucose Cotransporter 2 Inhibitors Use and Adverse Kidney Outcomes in Patients Receiving Contrast Media

The kidney benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients receiving contrast media remain unclear. This Taiwanese cohort study investigated the short- and long-term effects of SGLT2i on adverse kidney outcomes in patients receiving contrast media between January 1, 2016 and December 31, 2018. Patients who had used SGLT2i in the 90 days prior to receiving contrast media were matched with non-users. Cox proportional hazards regression was used to estimate the hazard ratio (HR) for the composite kidney outcome, which included acute kidney injury (AKI), acute kidney disease (AKD), and a sustained ≥ 30% reduction in estimated glomerular filtration rate (eGFR) confirmed after 3 months. The absolute mean change in eGFR over time was compared using a linear mixed-effects model. The final analysis included 1032 patients (SGLT2i: 344; control: 688). During follow-up, the overall composite adverse kidney event rate was 32.8%. Although the SGLT2i group had a lower event rate (29.94%) than the non-SGLT2i group (34.3%), this difference was not statistically significant (HR, 0.95; 95% CI, 0.75-1.20). Crucially, SGLT2i demonstrated a significant protective effect on long-term kidney function: the hazard for a ≥ 30% eGFR reduction was significantly lower in SGLT2i users (HR, 0.48; 95% CI, 0.29-0.81). Exploratory analyses showed that this benefit-a slower rate of kidney function deterioration-was consistent across subgroups, including men, patients under 65 years, individuals with baseline eGFR < 60 mL/min/1.73 m², and patients with diabetes. While SGLT2i showed no significant short-term protection against AKI or AKD, these findings strongly suggest that SGLT2i confers significant long-term reno-protective benefits for patients receiving contrast media.