SGLT2 Inhibitors and the Risk of Contrast-Associated Nephropathy Following Angiographic Intervention: Contradictory Concepts and Clinical Outcomes
Abstract
:1. Introduction
2. Renal Medullary Hypoxia, Diabetes and the Pathogenesis of CAN
3. SGLT2is and Renal Oxygenation: Aggravating Renal Medullary Hypoxia
4. Clinical Studies Indicating Reduced Risk of CAN in Patients on SGLT2is Undergoing Coronary Interventions
5. Summary and Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study | No. of Patients | Study Population | Contrast Volume (mL) | Baseline eGFR | CAN Definition | Statistical Methods | AKI Outcomes in Patients Given SGLT2i |
---|---|---|---|---|---|---|---|
Kültürsay et al. [10] | 130 of 295 on SGLT2is empagliflozin or dapagliflozin exposure for at least 6 months | Retrospective single-center study. Patients undergoing PCI for STEMI | Mean 291 and 265 mL in SGLT2i and control groups, respectively | ≥30 mL/min/1.73 m2 | A rise in sCr of ≥0.3 mg/dL above baseline within 48 h of contrast media exposure or an increase of at least 1.5 times the baseline value within 7 days | Doubly robust inverse probability weighted logistic regression analysis | AKI: lower occurrence, OR 0.86; 95% CI [0.76–0.98]; (p = 0.028) |
Paolisso et al. [9] | 111 of 646 on SGLT2i chronic SGLT2-I therapy (started at least 3 months before hospitalization) | Retrospective single-center study. Patients with AMI (STEMI and non-STEMI) | Median 180 mL [IQR 140–240] | ≥30 mL/min/1.73 m2 | Not clearly defined | Multivariable Cox regression model | AKI: lower occurrence, 5.4% vs. 13.1% (p = 0.022) |
Özkan and Gürdoğan [12] | 104 of 312 on SGLT2is, duration and timing of SGLT2 inhibitors were not indicated | Retrospective single-center study. Patients undergoing angiography with or without PCI | Mean 170 mL | ≥30 mL/min/1.73 m2 | sCr rise > 0.5 mg/dL or >25% above baseline within 48 h, or >1.5 times above baseline within 7 days or a urinary output of less than 0.5 mL/kg/h for at least 6 h | Multivariate binary logistic regression analysis | AKI: lower occurrence, OR 0.41, 95% CI [0.142–0.966]; p = 0.004 |
Hua et al. [8] | 242 on SGLT2is matched with 242 non-users, canagliflozin, empagliflozin or dapagliflozin for at least 6 months till the date of PCI | Retrospective single-center study. Patients undergoing angiography with or without PCI | Mean 141 and 149 mL in the SGLT2i and control groups, respectively | serum creatinine ≤ 2.5 ng/dL | sCr rise ≥ 0.5 mg/dL or >1.25 times above baseline within 72 h | Propensity score matching followed by McNemar’s test | AKI: lower occurrence, OR 0.37; 95% CI [0.19–0.67]; (p < 0.01) |
Meregildo-Rodriguez et al. [14] | 512 of 2572 on SGLT2is, the mean time of SGLT2 I therapy duration was 7.3 ± 3 months | Meta analysis of 4 observational studies following coronary angiography with or without PCI | Not reported | Not reported | Absolute increase in sCr by 0.3 to 0.5 mg/dL or 25 to 50% relative increase within 48–72 h following coronary intervention | Meta analysis | AKI: lower occurrence, RR 0.37; 95% CI [0.24–0.58] |
Feitosa MPM et al. [11] | 22 patients on iSGLT-2 and 20 controls. The SGLT2i empagliflozin 25 mg daily was initiated at least 15 days before PCI and maintained until the end of the follow-up period | Prospective single-center open-label, randomized study of patients undergoing elective PCI | 144 ± 66 mL in the SGLT2i users vs. 176 ± 54 mL in non-users | 62.1 ± 22.5 mL/min in SGLT2i users and 68.2 ± 17.7 mL/min in non-users | A 25% increase in baseline creatinine or an absolute increase of 0.5 mg/dL between 48 and 72 h after contrast administration | Chi-square test | There was no difference in the primary endpoint of the study |
Çabuk and Hazır [48] | 133 patients with DM on SGLT-2i matched with 212 non-users, patients who were using an SGLT2 inhibitor (empagliflozin or dapagliflozin) for at least 6 months | Cross-sectional and single-center study. Patients underwent CAG and/or PCI | 160.42 (±70.31) mL in the SGLT2i users vs. 158.72 (±81.24) mL in non-users | 71.44 mL/min (57.04–86.22) vs. 66.08 mL/min (52.23–84.16) | Increase in serum creatinine of ≥0.5 mg/dL or an absolute increase of ≥25% from baseline 72 h after CM exposure | Wilcoxon signed-rank test | CA-AKI incidence was significantly lower in patients using SGLT2 inhibitors (9.0%) compared with non-users (26.4%, p < 0.001). |
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Heyman, S.N.; Aronson, D.; Abassi, Z. SGLT2 Inhibitors and the Risk of Contrast-Associated Nephropathy Following Angiographic Intervention: Contradictory Concepts and Clinical Outcomes. Int. J. Mol. Sci. 2024, 25, 10759. https://doi.org/10.3390/ijms251910759
Heyman SN, Aronson D, Abassi Z. SGLT2 Inhibitors and the Risk of Contrast-Associated Nephropathy Following Angiographic Intervention: Contradictory Concepts and Clinical Outcomes. International Journal of Molecular Sciences. 2024; 25(19):10759. https://doi.org/10.3390/ijms251910759
Chicago/Turabian StyleHeyman, Samuel N., Doron Aronson, and Zaid Abassi. 2024. "SGLT2 Inhibitors and the Risk of Contrast-Associated Nephropathy Following Angiographic Intervention: Contradictory Concepts and Clinical Outcomes" International Journal of Molecular Sciences 25, no. 19: 10759. https://doi.org/10.3390/ijms251910759