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Reno-Protective Effects of SGLT2 Inhibitors in Patients With Diabetes Undergoing Percutaneous Coronary Intervention:
S Nabeel Hyder1, Milan Seth1, David E Hamilton1
1Division of Cardiology, Department of Internal Medicine, University of Michigan Medical School, Frankel Cardiovascular Center, Ann Arbor (S.N.H., M.S., D.E.H., H.S.G.).
Background:
Chronic therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) is associated with long-term reno-protective benefits. There are limited data on the benefits of these agents against the risk of contrast-associated acute kidney injury (CA-AKI).
Methods:
The retrospective study population included all patients with diabetes enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Percutaneous Coronary Intervention registry, a clinical registry of all percutaneous coronary intervention (PCI) cases at nonfederal hospitals in the state of Michigan. Included patients underwent PCI between January 2022 and September 2023. Patients on dialysis and those without post-PCI serum creatinine measurements were excluded. SGLT2i users were compared with nonusers with respect to CA-AKI outcomes, defined as an increase in serum creatinine of ≥0.5 mg/dL following PCI. Outcomes were evaluated in a risk-adjusted, propensity-matched analysis.
Results:
Among 13 804 patients with diabetes who underwent PCI, CA-AKI occurred in 3.8% (82/2186) of SGLT2i users versus 5.2% (602/11 618) of nonusers (odds ratio, 0.71; P=0.004). In propensity-matched, risk-adjusted analysis, the pre-PCI use of SGLT2i correlated with a lower incidence of CA-AKI (3.69% versus 4.68%; adjusted odds ratio, 0.72; P=0.027). The protective effect of SGLT2i was preserved among higher-risk subgroups.
Conclusions:
Among patients with diabetes who underwent PCI, preprocedural use of SGLT2i correlated with a lower risk of CA-AKI.
Insights
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduced the risk of contrast-associated acute kidney injury (CA-AKI) in diabetic patients undergoing percutaneous coronary intervention (PCI). This finding supports SGLT2i use for kidney protection in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Chronic sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy offers renal protection.
- Data on SGLT2i efficacy against contrast-associated acute kidney injury (CA-AKI) are limited.
Purpose of the Study:
- To evaluate the association between SGLT2i use and CA-AKI risk in diabetic patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A retrospective analysis of diabetic patients who underwent PCI between January 2022 and September 2023.
- Comparison of CA-AKI incidence between SGLT2i users and nonusers.
- Risk-adjusted, propensity-matched analysis to assess outcomes.
Main Results:
- CA-AKI occurred in 3.8% of SGLT2i users versus 5.2% of nonusers (OR 0.71, P=0.004).
- Propensity-matched analysis showed SGLT2i use correlated with lower CA-AKI incidence (3.69% vs 4.68%; adjusted OR 0.72, P=0.027).
- SGLT2i demonstrated a protective effect across higher-risk subgroups.
Conclusions:
- Preprocedural SGLT2i use is associated with a reduced risk of CA-AKI in diabetic patients undergoing PCI.
- SGLT2i may offer significant renal protection in this patient cohort.
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