SGLT2 Inhibitors Mitigate Contrast-Induced Acute Kidney Injury in Diabetes: Clinical and Experimental Evidence

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Contrast-induced acute kidney injury (CIAKI) is a significant complication for type 2 diabetes mellitus (T2DM) patients undergoing percutaneous coronary intervention (PCI).
• The potential renoprotective effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i) against CIAKI are not well-established.

Purpose of the Study:

• To investigate the efficacy of SGLT2 inhibitors in preventing CIAKI in T2DM patients undergoing PCI.
• To elucidate the underlying mechanisms of SGLT2 inhibitor action in preventing CIAKI using both clinical and experimental models.

Main Methods:

• A nationwide nested case-control study utilized Taiwan's National Health Insurance Research Database to analyze the association between SGLT2i use and the risk of post-PCI dialysis.
• In vitro studies examined dapagliflozin's effects on iopamidol-treated HK-2 cells.
• In vivo studies evaluated dapagliflozin's efficacy in diabetic rats exposed to iopamidol.

Main Results:

• SGLT2i use was significantly associated with a reduced risk of post-PCI dialysis (adjusted OR 0.33, 95% CI 0.14-0.76; p = 0.0094).
• In vitro, dapagliflozin mitigated iopamidol-induced cytotoxicity and NLRP3 inflammasome activation in HK-2 cells.
• In diabetic rats, dapagliflozin improved renal function, reduced tubular injury, and suppressed inflammasome-driven inflammation.

Conclusions:

• SGLT2 inhibitors demonstrate a protective effect against CIAKI in T2DM patients undergoing PCI.
• The renoprotective mechanisms involve the attenuation of tubular injury and suppression of inflammasome activation.
• SGLT2i represent a promising preventive strategy for CIAKI in this high-risk patient population.